Provider Demographics
NPI:1407447022
Name:JOHNSON, DAVID K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
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 1:1818 N HIGHWAY 66 STE A
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-3052
Mailing Address - Country:US
Mailing Address - Phone:918-739-4774
Mailing Address - Fax:918-739-4778
Practice Address - Street 1:1818 N HIGHWAY 66 STE A
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3052
Practice Address - Country:US
Practice Address - Phone:918-739-4774
Practice Address - Fax:918-739-4778
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200853870Medicaid