Provider Demographics
NPI:1508109729
Name:JOHNSON, DANETTE C (RPH)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25637 CONIFER RD
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9078
Mailing Address - Country:US
Mailing Address - Phone:303-816-4970
Mailing Address - Fax:303-816-4972
Practice Address - Street 1:25637 CONIFER RD
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9078
Practice Address - Country:US
Practice Address - Phone:303-816-4970
Practice Address - Fax:303-816-4970
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist