Healthcare Provider Details

I. General information

NPI: 1831151299
Provider Name (Legal Business Name): S. RAY JOHNSON PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: CAROL M. JOHNSON PHARMACIST

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S BLISS AVE
DUMAS TX
79029-4434
US

IV. Provider business mailing address

601 S BLISS AVE
DUMAS TX
79029-4434
US

V. Phone/Fax

Practice location:
  • Phone: 806-935-2333
  • Fax: 806-935-7096
Mailing address:
  • Phone: 806-935-2333
  • Fax: 806-935-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16082
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: