Provider Demographics
NPI:1174800262
Name:JOHNSON, JOSHUA OTIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:OTIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13963 BLUEBIRD ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4052
Mailing Address - Country:US
Mailing Address - Phone:763-331-2139
Mailing Address - Fax:
Practice Address - Street 1:3400 YANKEE DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1627
Practice Address - Country:US
Practice Address - Phone:651-662-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist