Provider Demographics
NPI:1467056952
Name:JOHNSON, TRISHA NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:NICOLE
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 1:200 COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6474
Mailing Address - Country:US
Mailing Address - Phone:507-217-6394
Mailing Address - Fax:
Practice Address - Street 1:1200 S RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2484
Practice Address - Country:US
Practice Address - Phone:507-446-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist