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NPI Code Detail

MEDICARE: DR. CHARLES ANTHONY JOHNSON PHARM D.

MEDICARE: DR. CHARLES ANTHONY JOHNSON PHARM D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist019830LA

General Provider Information

NPI Number : 1225396617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES ANTHONY JOHNSON PHARM D.
Provider Business Mailing Address
First Line : 761 PIERREMONT RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-2211
Country : US
Telephone Number : 318-861-3666
Fax Number :
Provider Business Practice Location Address
First Line : 761 PIERREMONT RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-2211
Country : US
Telephone Number : 318-861-3666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2012
Last Update Date : 08/09/2012

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