=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356317606
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHNNY LYNN COX PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 09/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 814 WORTH ST
-----------------------------------------------------
City | MOUNT AIRY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27030-4561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-786-4171
-----------------------------------------------------
Fax | 336-786-4991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 WORTH ST
-----------------------------------------------------
City | MOUNT AIRY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27030-4561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-786-4171
-----------------------------------------------------
Fax | 336-786-4991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 16344
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------