Provider Demographics
NPI:1942348024
Name:JOHNSON PHARMACY
Entity Type:Organization
Organization Name:JOHNSON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-589-2890
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72131-0164
Mailing Address - Country:US
Mailing Address - Phone:501-589-2890
Mailing Address - Fax:501-589-3780
Practice Address - Street 1:6124 HEBER SPRINGS RD WEST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:AR
Practice Address - Zip Code:72131-0164
Practice Address - Country:US
Practice Address - Phone:501-589-2890
Practice Address - Fax:501-589-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05864183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100542407Medicaid