Provider Demographics
NPI:1093857823
Name:JOHNSON PHARMACY OF FRIEND, INC.
Entity Type:Organization
Organization Name:JOHNSON PHARMACY OF FRIEND, INC.
Other - Org Name:JOHNSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:STYSKAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:402-947-2341
Mailing Address - Street 1:151 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FRIEND
Mailing Address - State:NE
Mailing Address - Zip Code:68359-1030
Mailing Address - Country:US
Mailing Address - Phone:402-947-2341
Mailing Address - Fax:402-947-5727
Practice Address - Street 1:151 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FRIEND
Practice Address - State:NE
Practice Address - Zip Code:68359-1030
Practice Address - Country:US
Practice Address - Phone:402-947-2341
Practice Address - Fax:402-947-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052860500Medicaid
NE47052860500Medicaid