Provider Demographics
NPI:1588992424
Name:JOHNSON, FORREST GALEN (PHARMD)
Entity type:Individual
Prefix:
First Name:FORREST
Middle Name:GALEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18900 HIGHWAY 105 W
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-6081
Mailing Address - Country:US
Mailing Address - Phone:936-582-0002
Mailing Address - Fax:936-582-0008
Practice Address - Street 1:18900 HIGHWAY 105 W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-6081
Practice Address - Country:US
Practice Address - Phone:936-582-0002
Practice Address - Fax:936-582-0008
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist