Healthcare Provider Details

I. General information

NPI: 1568764405
Provider Name (Legal Business Name): CARL THOMAS JOHNSON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 IRON BRIDGE RD
CHESTER VA
23831-1628
US

IV. Provider business mailing address

10800 IRON BRIDGE RD
CHESTER VA
23831-1628
US

V. Phone/Fax

Practice location:
  • Phone: 804-318-5580
  • Fax: 804-318-5582
Mailing address:
  • Phone: 804-318-5580
  • Fax: 804-318-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202208519
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: