Provider Demographics
NPI:1477831139
Name:JOHNSON, HEATHER L (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
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 1:2505 1ST ST S
Mailing Address - Street 2:T0661
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4215
Mailing Address - Country:US
Mailing Address - Phone:320-235-3026
Mailing Address - Fax:
Practice Address - Street 1:2505 1ST ST S
Practice Address - Street 2:T0661
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4215
Practice Address - Country:US
Practice Address - Phone:320-235-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist