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NPI Code Detail

MEDICARE: GARY K JOHNSON

MEDICARE: GARY K JOHNSON
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
1183500000XPharmacist47274TX

General Provider Information

NPI Number : 1417230939
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY K JOHNSON
Provider Business Mailing Address
First Line : 200 W COMMERCE ST
Second Line :
City : BROWNWOOD
State : TX
Zip : 76801-1806
Country : US
Telephone Number : 325-646-8923
Fax Number :
Provider Business Practice Location Address
First Line : 200 W COMMERCE ST
Second Line :
City : BROWNWOOD
State : TX
Zip : 76801-1806
Country : US
Telephone Number : 325-646-8923
Fax Number : 325-646-8938
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2011
Last Update Date : 09/21/2011

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