Provider Demographics
NPI:1023211067
Name:JOHNSON, BRIAN L (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 204
Mailing Address - Street 2:70 NORTH MAIN STREET, APT 3
Mailing Address - City:BETHEL
Mailing Address - State:VT
Mailing Address - Zip Code:05032
Mailing Address - Country:US
Mailing Address - Phone:802-392-1028
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist