Provider Demographics
NPI:1407244528
Name:JOHNSON, JOSHUA ROBERT (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ROBERT
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 1:1407 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4605
Mailing Address - Country:US
Mailing Address - Phone:815-758-0911
Mailing Address - Fax:815-758-2669
Practice Address - Street 1:1407 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4605
Practice Address - Country:US
Practice Address - Phone:815-758-0911
Practice Address - Fax:815-758-2669
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist