Provider Demographics
NPI:1184033771
Name:JOHNSON, JEFF (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
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 1:356 S 1210 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3273
Mailing Address - Country:US
Mailing Address - Phone:801-867-8502
Mailing Address - Fax:
Practice Address - Street 1:3798 S 700 E
Practice Address - Street 2:SUITE #7
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1150
Practice Address - Country:US
Practice Address - Phone:801-506-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6601439-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6601439-1701OtherUTAH DIVISION OF PROFESSIONAL LICENSING