Healthcare Provider Details

I. General information

NPI: 1043938202
Provider Name (Legal Business Name): CHET JOHNSON DRUGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 KELLER AVE N
AMERY WI
54001-1036
US

IV. Provider business mailing address

PO BOX 17
AMERY WI
54001-0017
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-8121
  • Fax: 715-268-4733
Mailing address:
  • Phone: 715-268-8121
  • Fax: 715-268-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW JOHNSON
Title or Position: OWNER
Credential: RPH
Phone: 715-268-8121