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NPI Code Detail

MEDICARE: MR. JONATHAN ALAN JOHNSON RPH

MEDICARE: MR. JONATHAN ALAN JOHNSON RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist0202010717VA

General Provider Information

NPI Number : 1568462927
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN ALAN JOHNSON RPH
Provider Business Mailing Address
First Line : 26080 CORNELIUS DR
Second Line :
City : ABINGDON
State : VA
Zip : 24211-6362
Country : US
Telephone Number : 276-676-0376
Fax Number : 276-783-1215
Provider Business Practice Location Address
First Line : 340 BAGLEY CIR
Second Line :
City : MARION
State : VA
Zip : 24354-3126
Country : US
Telephone Number : 276-783-1215
Fax Number : 276-783-8993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 07/08/2007

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