Healthcare Provider Details

I. General information

NPI: 1578981262
Provider Name (Legal Business Name): LARRY JOHNSON PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18928 AUBERRY RD
CLOVIS CA
93619-9641
US

IV. Provider business mailing address

18928 AUBERRY RD
CLOVIS CA
93619-9641
US

V. Phone/Fax

Practice location:
  • Phone: 559-908-0189
  • Fax:
Mailing address:
  • Phone: 559-908-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: