Healthcare Provider Details

I. General information

NPI: 1477419208
Provider Name (Legal Business Name): SAMUEL HENRY JOHNSON JR. PHARMD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

46 BEVERLY DR
DURHAM NC
27707-2224
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-4551
  • Fax: 919-470-4551
Mailing address:
  • Phone: 919-470-4551
  • Fax: 919-470-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number9699
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: