Provider Demographics
NPI:1477859452
Name:JOHNSONS HOMETOWN PHARMACY INC
Entity Type:Organization
Organization Name:JOHNSONS HOMETOWN PHARMACY INC
Other - Org Name:JOHNSON'S RIVER PLACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-315-4103
Mailing Address - Street 1:2625 OLD WINDER HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-7020
Mailing Address - Country:US
Mailing Address - Phone:770-967-1000
Mailing Address - Fax:770-967-1080
Practice Address - Street 1:2625 OLD WINDER HWY STE H
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-7021
Practice Address - Country:US
Practice Address - Phone:770-967-1000
Practice Address - Fax:770-967-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
GAPHRE0097263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109653AMedicaid
2128713OtherPK