Provider Demographics
NPI:1821364506
Name:JOHNSONS FAMILY PHARMACY AND COMPOUNDING LLC
Entity Type:Organization
Organization Name:JOHNSONS FAMILY PHARMACY AND COMPOUNDING LLC
Other - Org Name:JOHNSON'S FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-662-8899
Mailing Address - Street 1:109 PROFESSIONAL CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8347
Mailing Address - Country:US
Mailing Address - Phone:919-662-8899
Mailing Address - Fax:919-662-8945
Practice Address - Street 1:109 PROFESSIONAL CT STE 103
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8348
Practice Address - Country:US
Practice Address - Phone:919-662-8899
Practice Address - Fax:919-662-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111813336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3459977OtherNCPDP PROVIDER IDENTIFICATION NUMBER