Provider Demographics
NPI:1154073195
Name:JOHNSON, ROBERT JR (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7413
Mailing Address - Country:US
Mailing Address - Phone:901-515-8563
Mailing Address - Fax:
Practice Address - Street 1:6520 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-2402
Practice Address - Country:US
Practice Address - Phone:901-388-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45591OtherPHARMACIST LICENSE FROM TN BOARD OF PHARMACY