Provider Demographics
NPI:1306133178
Name:JOHANNES, STEVEN G (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:G
Last Name:JOHANNES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8623
Mailing Address - Country:US
Mailing Address - Phone:303-209-0107
Mailing Address - Fax:303-209-0107
Practice Address - Street 1:400 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8623
Practice Address - Country:US
Practice Address - Phone:303-209-0107
Practice Address - Fax:303-209-0107
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist