Provider Demographics
NPI:1760705305
Name:DEVADAS, JOHNSON (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JOHNSON
Middle Name:
Last Name:DEVADAS
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 1:20608 HOLLIS AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1428
Mailing Address - Country:US
Mailing Address - Phone:718-464-1556
Mailing Address - Fax:718-464-1558
Practice Address - Street 1:20608 HOLLIS AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1428
Practice Address - Country:US
Practice Address - Phone:718-464-1556
Practice Address - Fax:718-464-1558
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049327183500000X
CTPCT9552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist