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General NPI Number Information
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NPI Number | 1407898042
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Entity Type | Organization
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Legal Business Name | JOHNSON PHARMACY CORP
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 4562 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90022-1117
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Country | US
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Telephone | 323-796-0250
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Fax | 323-796-0251
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Provider Business Mailing Address
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Address Line | 2107 W COMMONWEALTH AVE STE D 375
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City | ALHAMBRA
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State | CA
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Zip | 91803-1435
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARVIN FONG
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Credential | PHARM D
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Telephone | 626-272-4373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY47297
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License Number State | CA
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