Provider Demographics
NPI:1609918739
Name:JOHNSON, JOHN TIMOTHY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TIMOTHY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-3473
Mailing Address - Country:US
Mailing Address - Phone:662-286-5759
Mailing Address - Fax:
Practice Address - Street 1:718 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-2458
Practice Address - Country:US
Practice Address - Phone:731-632-0995
Practice Address - Fax:731-632-9102
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist