Gina Teresa Johanson, PHARMD
Individual provider Active NPI Pharmacist · Flandreau, SD
NPI 1043841885 · NPPES record last updated Jan 30, 2020
Key facts
- NPI
- 1043841885
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 6573 (SD)
- Practice address
- 403 W Broad Ave
Flandreau, SD 57028-1630 - Phone
- (605) 997-2642
- Fax
- (605) 997-2586
- NPI assigned
- Jan 30, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6573 | SD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Flandreau Santee Sioux Tribe | Current |
Accepting new patients | |
| Flandreau Santee Sioux Tribe | Pharmacist | Current |
Accepting new patients |
Locations
403 W Broad Ave
Flandreau, SD 57028
Phone (605) 997-2642
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 6573 | SD | Yes |
Addresses
Primary practice location
403 W Broad Ave
Flandreau, SD 57028-1630
Mailing address
47726 SD Highway 32
Flandreau, SD 57028-6719
Phone (605) 941-5201
Other providers in Flandreau, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.