Provider Demographics
NPI:1235804816
Name:JOHNSON, TEVIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TEVIN
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 1:1297 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-4021
Mailing Address - Country:US
Mailing Address - Phone:954-973-3605
Mailing Address - Fax:954-973-3311
Practice Address - Street 1:1140 SW 36TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4835
Practice Address - Country:US
Practice Address - Phone:954-917-1737
Practice Address - Fax:954-642-0445
Is Sole Proprietor?:No
Enumeration Date:2021-08-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS62793OtherSTATE LICENSE NUMBER