Provider Demographics
NPI:1437284452
Name:S. RAY JOHNSON
Entity Type:Organization
Organization Name:S. RAY JOHNSON
Other - Org Name:PILL BOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-935-2333
Mailing Address - Street 1:601 S. BLISS AVE
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-4434
Mailing Address - Country:US
Mailing Address - Phone:806-935-2333
Mailing Address - Fax:806-935-7096
Practice Address - Street 1:601 S. BLISS AVE
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-4434
Practice Address - Country:US
Practice Address - Phone:806-935-2333
Practice Address - Fax:806-935-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02472333600000X
TX333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010675903Medicaid
TX45D0952363OtherCLIA
TX20002809OtherDPS CONTROLLED DRUGS NO
TX010675902Medicaid
TX143922Medicaid
TX02472OtherPHCY STORE LICENSE
TX16082OtherS RAY JOHNSON PHCY LIC #
TX010675901Medicaid
1133640001Medicare PIN
1133640001Medicare ID - Type UnspecifiedIDENTIFICATION NO.
TX143922Medicaid