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General NPI Number Information
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NPI Number | 1104260595
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Entity Type | Individual
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Provider Name | SCOTT C. JOHNSON PHARMD,
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Gender | Male
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 1295 PARKWAY DR
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City | BLACKFOOT
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State | ID
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Zip | 83221-1683
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Country | US
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Telephone | 208-785-1311
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Fax |
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Provider Business Mailing Address
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Address Line | 129 E 600 N
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City | BLACKFOOT
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State | ID
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Zip | 83221-5772
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Country | US
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Telephone | 208-604-4238
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P6540
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License Number State | ID
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