Provider Demographics
NPI:1801178041
Name:JOHNSON, GARRET DONALD (PHARM D)
Entity type:Individual
Prefix:
First Name:GARRET
Middle Name:DONALD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 LEXINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123
Mailing Address - Country:US
Mailing Address - Phone:651-686-1090
Mailing Address - Fax:
Practice Address - Street 1:4220 LEXINGTON AVE S
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1975
Practice Address - Country:US
Practice Address - Phone:651-686-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1179281835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy