Healthcare Provider Details

I. General information

NPI: 1649673922
Provider Name (Legal Business Name): PAUL JOHNSON BAS MOLINA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12058 PALMDALE RD
ADELANTO CA
92301-6708
US

IV. Provider business mailing address

12058 PALMDALE RD
ADELANTO CA
92301-6708
US

V. Phone/Fax

Practice location:
  • Phone: 760-246-2803
  • Fax:
Mailing address:
  • Phone: 760-246-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: