Individual
KENT LAWRENCE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1775 THOMPSON RD, COOS BAY, OR 97420-2125
(541) 269-8160
Mailing address
965 S 4TH ST, COOS BAY, OR 97420-1409
(541) 266-9774
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9766
OR
Other
Enumeration date
02/19/2007
Last updated
07/08/2007
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