Provider Demographics
NPI:1679062319
Name:JOHNSON, DANIEL HOWARD (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HOWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 APPALACHIAN HWY
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2834
Mailing Address - Country:US
Mailing Address - Phone:423-566-5323
Mailing Address - Fax:423-566-5325
Practice Address - Street 1:2824 APPALACHIAN HWY
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2834
Practice Address - Country:US
Practice Address - Phone:423-566-5323
Practice Address - Fax:423-566-5325
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2167OtherPHARMACY