Provider Demographics
NPI:1831151299
Name:JOHNSON, S. RAY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:S.
Middle Name:RAY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:601 S BLISS AVE
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-4434
Mailing Address - Country:US
Mailing Address - Phone:806-935-2333
Mailing Address - Fax:806-935-7096
Practice Address - Street 1:601 S BLISS AVE
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-4434
Practice Address - Country:US
Practice Address - Phone:806-935-2333
Practice Address - Fax:806-935-7096
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX02472OtherPHARMACY LICENSE #
TX03720663OtherDRIVER'S LICENSE #
TX16082OtherLIC # S.RAY JOHNSON
TX16435OtherLIC#-CAROL M. JOHNSON
TX143922Medicaid
TX20002809OtherDPS-CONTROLLED DRUGS #
TX20002809OtherDPS-CONTROLLED DRUGS #
TX143922Medicaid