Provider Demographics
NPI:1508202854
Name:JOHNSON, PHILIP SCOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CLAYPOOL HILL MALL
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609
Mailing Address - Country:US
Mailing Address - Phone:276-963-1067
Mailing Address - Fax:276-964-6344
Practice Address - Street 1:1051 CLAYPOOL HILL MALL RD STE 1
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-8201
Practice Address - Country:US
Practice Address - Phone:276-963-1067
Practice Address - Fax:276-964-6344
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist