Individual
KEVIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
516 NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1185
Mailing address
503 ZECCA DR, GALLUP, NM 87301-4846
(505) 726-2897
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
17050
CO
183500000X
Pharmacist
Primary
RP00006839
NM
Other
Enumeration date
09/21/2006
Last updated
07/08/2007
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