Provider Demographics
NPI:1477073351
Name:JOHNSON, MARQUIS DEON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARQUIS
Middle Name:DEON
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 1:1051 SOUTHERN DR UNIT 408
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-5191
Mailing Address - Country:US
Mailing Address - Phone:803-566-9004
Mailing Address - Fax:
Practice Address - Street 1:4627 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5980
Practice Address - Country:US
Practice Address - Phone:803-786-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist