Provider Demographics
NPI:1366838377
Name:JOHNSON DRUG WILLIAMSBURG
Entity Type:Organization
Organization Name:JOHNSON DRUG WILLIAMSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28541-0250
Mailing Address - Country:US
Mailing Address - Phone:910-347-5185
Mailing Address - Fax:910-347-9298
Practice Address - Street 1:2200 GUM BRANCH RD STE I
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4568
Practice Address - Country:US
Practice Address - Phone:910-938-0582
Practice Address - Fax:910-938-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC088663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy