Provider Demographics
NPI:1043933674
Name:JOHNSON, PAUL JR
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 JEAN LAFITTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFITTE
Mailing Address - State:LA
Mailing Address - Zip Code:70067-5205
Mailing Address - Country:US
Mailing Address - Phone:504-689-4122
Mailing Address - Fax:504-689-4125
Practice Address - Street 1:4057 S WINDMERE ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2237
Practice Address - Country:US
Practice Address - Phone:504-689-4122
Practice Address - Fax:504-689-4125
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist