Provider Demographics
NPI:1326333139
Name:JOHNSON, SCOTT DANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DANIEL
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 1:718 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3910
Mailing Address - Country:US
Mailing Address - Phone:402-597-9499
Mailing Address - Fax:402-597-5499
Practice Address - Street 1:718 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3910
Practice Address - Country:US
Practice Address - Phone:402-597-9499
Practice Address - Fax:402-597-5499
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist