Healthcare Provider Details

I. General information

NPI: 1942348024
Provider Name (Legal Business Name): JOHNSON PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 HEBER SPRINGS RD WEST
QUITMAN AR
72131-0164
US

IV. Provider business mailing address

PO BOX 164
QUITMAN AR
72131-0164
US

V. Phone/Fax

Practice location:
  • Phone: 501-589-2890
  • Fax: 501-589-3780
Mailing address:
  • Phone: 501-589-2890
  • Fax: 501-589-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD05864
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J JOHNSON
Title or Position: PRES
Credential:
Phone: 501-589-2890