Provider Demographics
NPI:1740873546
Name:JOHNSON, PAUL GILBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GILBERT
Last Name:JOHNSON
Suffix:
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 1:2209 COUNTY ROAD 140
Mailing Address - Street 2:
Mailing Address - City:LORAINE
Mailing Address - State:TX
Mailing Address - Zip Code:79532-3009
Mailing Address - Country:US
Mailing Address - Phone:325-236-5220
Mailing Address - Fax:
Practice Address - Street 1:2250 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-3036
Practice Address - Country:US
Practice Address - Phone:325-728-3489
Practice Address - Fax:325-728-8836
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist