Provider Demographics
NPI:1982204657
Name:JOHNSON, ALLAN M
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:ORONOCO
Mailing Address - State:MN
Mailing Address - Zip Code:55960-1464
Mailing Address - Country:US
Mailing Address - Phone:507-421-3895
Mailing Address - Fax:
Practice Address - Street 1:4221 W CIRCLE DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8788
Practice Address - Country:US
Practice Address - Phone:507-292-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist