MEDICARE: DR. GLEN RALPH JOHNSON PHARMD

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
1	183500000X	Pharmacist	RPH009914	GA
2	183500000X	Pharmacist	PS 12439	FL

General Provider Information

NPI Number	:	1427291608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN RALPH JOHNSON PHARMD

Provider Business Mailing Address
First Line	:	901 SANTA FE TRL
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-3724
Country	:	US
Telephone Number	:	478-737-9920
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 SANTA FE TRL
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-3724
Country	:	US
Telephone Number	:	478-474-1240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	10/26/2016

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