Organization
FORMULATION MATERIALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRYL LATEEF JOHNSON II (CEO)
(213) 800-9815
Entity
Organization
Contact information
Practice address
9121 DARWIN RD, PHELAN, CA 92371-9294
(213) 800-9815
Mailing address
9121 DARWIN RD, PHELAN, CA 92371-9294
(213) 800-9815
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/29/2026
Last updated
04/29/2026
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