Provider Demographics
NPI:1063504884
Name:JOHNSON, DAVID KENT (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KENT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5946
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5946
Mailing Address - Country:US
Mailing Address - Phone:325-668-4818
Mailing Address - Fax:
Practice Address - Street 1:2501 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-5058
Practice Address - Country:US
Practice Address - Phone:325-795-3596
Practice Address - Fax:325-795-3203
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist