Provider Demographics
NPI:1023440484
Name:JOHNSON, DEREK JAMES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JAMES
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 1:3131 ROSLYN WAY UNIT 211
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2413
Mailing Address - Country:US
Mailing Address - Phone:720-560-1849
Mailing Address - Fax:
Practice Address - Street 1:8031 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-1645
Practice Address - Country:US
Practice Address - Phone:303-420-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist