Provider Demographics
NPI:1215198445
Name:JOHNSON, DARCY ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DARCY
Middle Name:ALAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43500 MIGIZI DR
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56539-2236
Mailing Address - Country:US
Mailing Address - Phone:320-532-4770
Mailing Address - Fax:320-532-4705
Practice Address - Street 1:43500 MIGIZI DR
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56539-2236
Practice Address - Country:US
Practice Address - Phone:320-532-4770
Practice Address - Fax:320-532-4705
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist