MEDICARE: MR. RICHARD LEROY JOHNSON RPH

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	WY-2307	WY

General Provider Information

NPI Number	:	1487790382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD LEROY JOHNSON RPH

Provider Business Mailing Address
First Line	:	845 S BEECH ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-3701
Country	:	US
Telephone Number	:	307-472-0597
Fax Number	:	307-237-7748

Provider Business Practice Location Address
First Line	:	2546 E 2ND ST STE 100
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-2062
Country	:	US
Telephone Number	:	307-472-0597
Fax Number	:	307-237-7748

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. RICHARD LEROY JOHNSON RPH” Practice Location

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