Provider Demographics
NPI:1346563228
Name:JOHNSON, PATRICK (PHARMD, MPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W LAKE SUITE 1100 CAMPUS MAIL DELIVERY 8031
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-7046
Mailing Address - Country:US
Mailing Address - Phone:970-491-1402
Mailing Address - Fax:
Practice Address - Street 1:151 W LAKE ST SUITE 1100 CAMPUS DELIVERY 8031
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-7046
Practice Address - Country:US
Practice Address - Phone:970-491-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011220183500000X
COPHA.0020456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist