Provider Demographics
NPI:1033426143
Name:JOHNSON DRUG COMPANY, INC
Entity Type:Organization
Organization Name:JOHNSON DRUG COMPANY, INC
Other - Org Name:JOHNSON HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-347-5185
Mailing Address - Street 1:714 NEW BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5435
Mailing Address - Country:US
Mailing Address - Phone:910-347-5185
Mailing Address - Fax:910-347-9298
Practice Address - Street 1:8207 MARKET ST
Practice Address - Street 2:SUITE I
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8889
Practice Address - Country:US
Practice Address - Phone:910-686-2988
Practice Address - Fax:910-686-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00998332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0348010002Medicare NSC