MEDICARE: MR. ROBERT JOHNSON JR. PHARM. D.

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	183500000X	Pharmacist	45591	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45591	OTHER	TN	PHARMACIST LICENSE FROM TN BOARD OF PHARMACY

General Provider Information

NPI Number	:	1154073195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JOHNSON JR. PHARM. D.

Provider Business Mailing Address
First Line	:	2399 RIDGEWAY RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-7413
Country	:	US
Telephone Number	:	901-515-8563
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 MEMPHIS ARLINGTON RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-2402
Country	:	US
Telephone Number	:	901-388-4331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	01/20/2022

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