Healthcare Provider Details

I. General information

NPI: 1497366272
Provider Name (Legal Business Name): RUFUS LEE JOHNSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

2050 GOVERNMENT ST
MOBILE AL
36606-1622
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16296
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: