Provider Demographics
NPI:1457819708
Name:JOHNSON, DEBORAH ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N BENT ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2712
Mailing Address - Country:US
Mailing Address - Phone:307-754-2031
Mailing Address - Fax:307-754-4859
Practice Address - Street 1:140 N BENT ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2712
Practice Address - Country:US
Practice Address - Phone:307-754-2031
Practice Address - Fax:307-754-4859
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist