Provider Demographics
NPI:1649588195
Name:JOHNSON RX INC
Entity Type:Organization
Organization Name:JOHNSON RX INC
Other - Org Name:SUMMERVILLE DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COPELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-504-2253
Mailing Address - Street 1:9848 ROME BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-1586
Mailing Address - Country:US
Mailing Address - Phone:706-808-0606
Mailing Address - Fax:706-808-0609
Practice Address - Street 1:9848 ROME BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1586
Practice Address - Country:US
Practice Address - Phone:706-808-0606
Practice Address - Fax:706-808-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0096923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126792OtherPK