Healthcare Provider Details

I. General information

NPI: 1285570648
Provider Name (Legal Business Name): RICHARD JOHNSON DR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PALOMINO LN STE 220
LAS VEGAS NV
89106-4891
US

IV. Provider business mailing address

2020 PALOMINO LN STE 220
LAS VEGAS NV
89106-4891
US

V. Phone/Fax

Practice location:
  • Phone: 833-649-4643
  • Fax: 833-649-4643
Mailing address:
  • Phone: 833-649-4643
  • Fax: 833-649-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08550
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: