MEDICARE: JOHNSON RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	114403	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2147427	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124427851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON RX INC

Provider Business Mailing Address
First Line	:	4055 ALABAMA HWY 9
Second Line	:	SUITE F
City	:	CEDAR BLUFF
State	:	AL
Zip	:	35959
Country	:	US
Telephone Number	:	256-779-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1642 PELHAM RD S
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3312
Country	:	US
Telephone Number	:	256-706-6845
Fax Number	:	888-537-4507

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	COPELAND JOHNSON
Credential	:	PHARMACIST
Telephone Number	:	256-504-2253

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	03/24/2017

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Directions to “JOHNSON RX INC ” Practice Location

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