Provider Demographics
NPI:1669722468
Name:DERANEK, JOHN W (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:DERANEK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HOFFMAN DR
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2348
Mailing Address - Country:US
Mailing Address - Phone:507-451-0240
Mailing Address - Fax:507-451-5134
Practice Address - Street 1:410 HOFFMAN DR
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2348
Practice Address - Country:US
Practice Address - Phone:507-451-0240
Practice Address - Fax:507-451-5134
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist