Provider Demographics
NPI:1174957716
Name:JOHNSON, JASON GEORGE (RPH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:GEORGE
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 1:27431 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-6401
Mailing Address - Country:US
Mailing Address - Phone:985-882-2828
Mailing Address - Fax:985-882-6679
Practice Address - Street 1:27431 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-6401
Practice Address - Country:US
Practice Address - Phone:985-882-2828
Practice Address - Fax:985-882-6679
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA16847OtherLA BOARD OF PHARMACY