Provider Demographics
NPI:1841588316
Name:JOHNSON, LARRY BRIAN (RPH)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:BRIAN
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-0100
Mailing Address - Country:US
Mailing Address - Phone:530-339-1932
Mailing Address - Fax:530-335-3655
Practice Address - Street 1:37435 MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4372
Practice Address - Country:US
Practice Address - Phone:530-335-4860
Practice Address - Fax:530-335-3655
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist