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General NPI Number Information
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NPI Number | 1770667560
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Entity Type | Organization
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Legal Business Name | GARY P JOHNSON
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 112 MAIN ST
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City | WINDSOR
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State | NY
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Zip | 13865
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Country | US
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Telephone | 607-655-1443
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Fax | 607-655-3717
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Provider Business Mailing Address
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Address Line | 112 MAIN ST PO BOX 100
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City | WINDSOR
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State | NY
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Zip | 13865
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Country | US
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Telephone | 607-655-1443
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Fax | 607-655-3717
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY PAUL JOHNSON
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Credential | RPH
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Telephone | 607-655-1443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 022276
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License Number State | NY
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