Provider Demographics
NPI:1124303268
Name:JOHNSON, DERICK LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:DERICK
Middle Name:LYNN
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 1:14302 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-5504
Mailing Address - Country:US
Mailing Address - Phone:281-255-6289
Mailing Address - Fax:281-378-2451
Practice Address - Street 1:14302 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-5504
Practice Address - Country:US
Practice Address - Phone:281-255-6289
Practice Address - Fax:281-378-2451
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11801183500000X
TX52487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist