Individual
DEWAYNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD.
Contact information
Practice address
10320 MAIN ST, FAIRFAX, VA 22030-2410
(703) 591-1025
Mailing address
10320 MAIN ST, FAIRFAX, VA 22030-2410
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202209750
VA
Other
Enumeration date
01/24/2012
Last updated
01/24/2012
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