Active NPI
Dewayne Johnson, PHARMD.
- Pharmacist
- Fairfax, VA
National Provider Identifier
1710258652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202209750
- Practice address
- 10320 Main St
Fairfax, VA 22030-2410 - Phone
- (703) 591-1025
- NPI assigned
- Jan 24, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202209750 | VA | Primary |
Addresses
Primary practice location
10320 Main St
Fairfax, VA 22030-2410
Mailing address
10320 Main St
Fairfax, VA 22030-2410
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202209750 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327363200000",
"number": "1710258652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10320 MAIN ST",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10320 MAIN ST",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302410",
"telephone_number": "703-591-1025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "DEWAYNE",
"credential": "PHARMD.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-24",
"last_updated": "2012-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202209750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.