Healthcare Provider Details

I. General information

NPI: 1336959618
Provider Name (Legal Business Name): JAMES CLAY JOHNSON III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 EAST ST APT 410
CLINTON MS
39056-4229
US

IV. Provider business mailing address

310 MEADOWBROOK RD
JACKSON MS
39206-5328
US

V. Phone/Fax

Practice location:
  • Phone: 662-523-2269
  • Fax:
Mailing address:
  • Phone: 601-362-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-101676
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: