Provider Demographics
NPI:1942482229
Name:JOHNSON RX PROPERTIES, LLC
Entity Type:Organization
Organization Name:JOHNSON RX PROPERTIES, LLC
Other - Org Name:JOHNSON RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:COPELAND
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-779-3000
Mailing Address - Street 1:4055 AL HIGHWAY 9
Mailing Address - Street 2:STE F
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35959-5099
Mailing Address - Country:US
Mailing Address - Phone:256-779-3000
Mailing Address - Fax:256-779-3002
Practice Address - Street 1:4055 AL HIGHWAY 9
Practice Address - Street 2:STE F
Practice Address - City:CEDAR BLUFF
Practice Address - State:AL
Practice Address - Zip Code:35959-5099
Practice Address - Country:US
Practice Address - Phone:256-779-3000
Practice Address - Fax:256-779-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BX2000X, 333600000X
AL1130323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003182032AMedicaid
1996181OtherPK
AL100040202Medicaid
GA003182032AMedicaid