Provider Demographics
NPI:1033490248
Name:JOHNSON, GARRY ALAN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:ALAN
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-5607
Mailing Address - Country:US
Mailing Address - Phone:302-832-0222
Mailing Address - Fax:
Practice Address - Street 1:119 W HARVEST DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-5607
Practice Address - Country:US
Practice Address - Phone:302-832-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist