Provider Demographics
NPI:1386158301
Name:JOHNSON, ANDREA COLLIER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:COLLIER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:COLLIER-JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5772 JILLIAN WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5772 JILLIAN WAY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-0418
Practice Address - Country:US
Practice Address - Phone:203-253-4685
Practice Address - Fax:817-375-3932
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist