Provider Demographics
NPI:1639503220
Name:JOHNDROW, DEREK MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:MICHAEL
Last Name:JOHNDROW
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 1:1215 N LANDING WAY
Mailing Address - Street 2:T-2290
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5521
Mailing Address - Country:US
Mailing Address - Phone:518-461-3129
Mailing Address - Fax:
Practice Address - Street 1:1215 N LANDING WAY
Practice Address - Street 2:T-2290
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5521
Practice Address - Country:US
Practice Address - Phone:425-207-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60389484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist