Provider Demographics
NPI:1407898042
Name:JOHNSON PHARMACY CORP
Entity Type:Organization
Organization Name:JOHNSON PHARMACY CORP
Other - Org Name:L A GOOD NEIGHBOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-272-4373
Mailing Address - Street 1:2107 W COMMONWEALTH AVE
Mailing Address - Street 2:STE D 375
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4562 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1117
Practice Address - Country:US
Practice Address - Phone:323-796-0250
Practice Address - Fax:323-796-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY472973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA47297Medicaid
5616707OtherOTHER ID NUMBER