Provider Demographics
NPI:1629647722
Name:JOHNSON, BYRON EDNEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:EDNEY
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 1:1305 MYRNA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-9746
Mailing Address - Country:US
Mailing Address - Phone:501-516-2172
Mailing Address - Fax:
Practice Address - Street 1:1132 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2158
Practice Address - Country:US
Practice Address - Phone:870-594-0760
Practice Address - Fax:870-594-0795
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist