Provider Demographics
NPI:1225031685
Name:JOHNSON, JEREMY LOREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LOREN
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 1:800 27TH ST SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-5400
Mailing Address - Country:US
Mailing Address - Phone:507-434-0842
Mailing Address - Fax:
Practice Address - Street 1:1707 2ND ST SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1985
Practice Address - Country:US
Practice Address - Phone:507-434-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117762-8183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist