Healthcare Provider Details

I. General information

NPI: 1841588316
Provider Name (Legal Business Name): LARRY BRIAN JOHNSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37435 MAIN ST
BURNEY CA
96013-4372
US

IV. Provider business mailing address

PO BOX 100
BURNEY CA
96013-0100
US

V. Phone/Fax

Practice location:
  • Phone: 530-335-4860
  • Fax: 530-335-3655
Mailing address:
  • Phone: 530-339-1932
  • Fax: 530-335-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: