NPI 1467535799

Brian a Johnson MD PC

Organisation Non-Pharmacy Dispensing Site Winamac, IN

Practice location

Address: 613 Terrace Dr, Winamac, IN 46996-1111
Phone: (574) 946-6644

Authorised official

Name: Direndia Shackelford
Title: Managed Care Specialist
Phone: (800) 654-0889

Registered specialties

Non-Pharmacy Dispensing Site Primary

Suppliers Taxonomy 332900000X Licence 5003424A (IN)

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Registry record

NPI: 1467535799
Entity type: Organization
NPI issued: 23 Oct 2006
Record last updated: 20 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.