Brian Clay Johnson
Individual provider Active NPI Pharmacist · Many, LA
NPI 1780456392 · NPPES record last updated Oct 26, 2023
Key facts
- NPI
- 1780456392
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 15450 (LA)
- Practice address
- 25800 Highway 171
Many, LA 71449-6976 - Phone
- (318) 256-9207
- NPI assigned
- Oct 26, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15450 | LA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15450 | LA | Yes |
Addresses
Primary practice location
25800 Highway 171
Many, LA 71449-6976
Mailing address
430 Ellis Rd
Deridder, LA 70634-3132
Phone (337) 462-5653
Other providers in Many, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.