Most Relevant Information
Provider Data
| NPI Number: | 1003337841 |
| Provider Name: | LARISSA LYNN JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 21192 |
Most Important Dates
| Enumeration Date: | 07/02/2017 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
2503 W 5TH ST
LUMBERTON
NC
283587815
Practice Location Phone/Fax
| Phone: | 9108876122 |
| Fax: | 9108876123 |
Provider Mailing Location
2503 W 5TH ST
LUMBERTON
NC
28372
Provider Mailing Phone/Fax
| Phone: | 9108876122 |
| Fax: | 9108876123 |