Individual
AMY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1123 ADAMS AVE, LA GRANDE, OR 97850
(541) 963-5741
Mailing address
69542 HAEFER LANE, COVE, OR 97824
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3567
WY
183500000X
Pharmacist
RPH-0014388
OR
Other
Enumeration date
07/06/2015
Last updated
07/06/2015
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