Provider Demographics
NPI:1871983437
Name:JOHNSON, DANIEL J
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
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 1:726 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2151
Mailing Address - Country:US
Mailing Address - Phone:615-875-0080
Mailing Address - Fax:
Practice Address - Street 1:726 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2151
Practice Address - Country:US
Practice Address - Phone:615-875-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-113588183500000X
WVRP0012474183500000X
ORRPH-0018534183500000X
SC36733183500000X
NC26030183500000X
TN44437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist