Provider Demographics
NPI:1043596935
Name:JOHNSON, ANDREW M (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
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 1:15098 E STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1316
Mailing Address - Country:US
Mailing Address - Phone:605-360-0931
Mailing Address - Fax:
Practice Address - Street 1:950 S QUEBEC ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2003
Practice Address - Country:US
Practice Address - Phone:303-388-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18284183500000X
SD5653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist