Provider Demographics
NPI:1699273995
Name:JOHNSON, DANIEL SCOTT (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1048
Mailing Address - Country:US
Mailing Address - Phone:574-936-8388
Mailing Address - Fax:
Practice Address - Street 1:2014 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1048
Practice Address - Country:US
Practice Address - Phone:574-936-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027421A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26027421AOtherINDIANA STATE BOARD OF PHARMACY