Provider Demographics
NPI:1699181065
Name:JOHNSON, ZACHARY DREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DREY
Last Name:JOHNSON
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 1:2252 N 44TH ST
Mailing Address - Street 2:#1082
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3200
Mailing Address - Country:US
Mailing Address - Phone:480-282-7378
Mailing Address - Fax:
Practice Address - Street 1:9546 E RIGGS RD
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-7463
Practice Address - Country:US
Practice Address - Phone:480-895-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist