Provider Demographics
NPI:1013610641
Name:CHET JOHNSON DRUG CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:CHET JOHNSON DRUG CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-268-8121
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-0017
Mailing Address - Country:US
Mailing Address - Phone:715-268-8121
Mailing Address - Fax:715-268-4733
Practice Address - Street 1:204 KELLER AVE N
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1036
Practice Address - Country:US
Practice Address - Phone:715-268-8121
Practice Address - Fax:715-268-4733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHET JOHNSON DRUGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy