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Individual

DR. GLEN RALPH JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHARMD

Contact information

Practice address
901 SANTA FE TRL, MACON, GA 31220-3724
(478) 474-1240
Mailing address
901 SANTA FE TRL, MACON, GA 31220-3724
(478) 737-9920

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
PS 12439
FL
183500000X
Pharmacist
Primary
RPH009914
GA

Other

Enumeration date
04/17/2009
Last updated
10/26/2016
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