Provider Demographics
NPI:1578770327
Name:JOHNSON, JEREMY LOWELL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LOWELL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 W 119TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:SUITE 2H29
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2553
Practice Address - Country:US
Practice Address - Phone:918-660-3007
Practice Address - Fax:918-660-3009
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK128531835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy