Healthcare Provider Details

I. General information

NPI: 1437284452
Provider Name (Legal Business Name): S. RAY JOHNSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/30/2008
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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02472
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateTX

VIII. Authorized Official

Name: S RAY JOHNSON
Title or Position: PHARMACIST OWNER
Credential: RPH
Phone: 806-935-2333