Healthcare Provider Details

I. General information

NPI: 1801018486
Provider Name (Legal Business Name): NEAL KEITH JOHNSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 COORS RD NW ALBERTSONS SAV ON PHARMACY STORE # 937
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

1100 WAGON WHEEL SE
ALBUQUERQUE NM
87123-4247
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-3961
  • Fax: 505-897-0071
Mailing address:
  • Phone: 505-292-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP4152
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: