Provider Demographics
NPI:1801018486
Name:JOHNSON, NEAL KEITH (RPH)
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:KEITH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 WAGON WHEEL SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-4247
Mailing Address - Country:US
Mailing Address - Phone:505-292-1870
Mailing Address - Fax:
Practice Address - Street 1:10131 COORS RD NW
Practice Address - Street 2:ALBERTSONS SAV ON PHARMACY STORE # 937
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-897-3961
Practice Address - Fax:505-897-0071
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP4152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist