Provider Demographics
NPI:1336959618
Name:JOHNSON, JAMES CLAY III (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CLAY
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5328
Mailing Address - Country:US
Mailing Address - Phone:601-362-6409
Mailing Address - Fax:
Practice Address - Street 1:408 EAST ST APT 410
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4229
Practice Address - Country:US
Practice Address - Phone:662-523-2269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist