MEDICARE: GARY W 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
1	183500000X	Pharmacist	20777	TX

General Provider Information

NPI Number	:	1639724842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY W JOHNSON RPH

Provider Business Mailing Address
First Line	:	PO BOX 185
Second Line	:
City	:	DALHART
State	:	TX
Zip	:	79022-0185
Country	:	US
Telephone Number	:	806-717-9416
Fax Number	:	806-249-9717

Provider Business Practice Location Address
First Line	:	1601 TENNESSEE AVE
Second Line	:
City	:	DALHART
State	:	TX
Zip	:	79022-5110
Country	:	US
Telephone Number	:	806-249-4772
Fax Number	:	806-249-9717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2019

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Directions to “ GARY W JOHNSON RPH” Practice Location

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