Provider Demographics
NPI:1326385220
Name:JOHNSON PHARMACY OF MERRILL LLC
Entity Type:Organization
Organization Name:JOHNSON PHARMACY OF MERRILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-539-2772
Mailing Address - Street 1:1021 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-2504
Mailing Address - Country:US
Mailing Address - Phone:715-539-2772
Mailing Address - Fax:715-539-0757
Practice Address - Street 1:1021 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2504
Practice Address - Country:US
Practice Address - Phone:715-539-2772
Practice Address - Fax:715-539-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9185-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0360150001Medicare NSC