Provider Demographics
NPI:1124427851
Name:JOHNSON RX INC
Entity type:Organization
Organization Name:JOHNSON RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:COPELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:256-504-2253
Mailing Address - Street 1:4055 ALABAMA HWY 9
Mailing Address - Street 2:SUITE F
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35959
Mailing Address - Country:US
Mailing Address - Phone:256-779-3000
Mailing Address - Fax:
Practice Address - Street 1:1642 PELHAM RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3312
Practice Address - Country:US
Practice Address - Phone:256-706-6845
Practice Address - Fax:888-537-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1144033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147427OtherPK
AL165475Medicaid