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General NPI Number Information
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NPI Number | 1780456392
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Entity Type | Individual
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Provider Name | MR. BRIAN CLAY JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 25800 HIGHWAY 171
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City | MANY
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State | LA
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Zip | 71449-6976
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Country | US
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Telephone | 318-256-9207
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Fax |
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Provider Business Mailing Address
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Address Line | 430 ELLIS RD
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City | DERIDDER
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State | LA
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Zip | 70634-3132
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Country | US
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Telephone | 337-462-5653
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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 | 15450
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License Number State | LA
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