Individual
KELLY LYNN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
2130 MARCOLA RD, SPRINGFIELD, OR 97477-2592
(541) 747-3362
(541) 741-2287
Mailing address
4930 DAISY ST, SPRINGFIELD, OR 97478-6797
(541) 912-2563
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CPT-002894
OR
Other
Enumeration date
07/12/2021
Last updated
07/12/2021
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