Provider Demographics
NPI:1942618574
Name:JOHNSON, TIMOTHY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
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 1:350 S MOAPA VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:NV
Mailing Address - Zip Code:89040
Mailing Address - Country:US
Mailing Address - Phone:702-397-2308
Mailing Address - Fax:702-397-2348
Practice Address - Street 1:350 MOAPA VALLEY BOULEVARD
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:NV
Practice Address - Zip Code:89040
Practice Address - Country:US
Practice Address - Phone:702-397-2308
Practice Address - Fax:702-397-2348
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7408750-1701183500000X
NV19232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist