Healthcare Provider Details

I. General information

NPI: 1023211067
Provider Name (Legal Business Name): BRIAN L JOHNSON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

P.O. BOX 204 70 NORTH MAIN STREET, APT 3
BETHEL VT
05032
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5593
  • Fax:
Mailing address:
  • Phone: 802-392-1028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3474
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: