MEDICARE: JACOB M. JOHNSON PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	14796	AL

General Provider Information

NPI Number	:	1306844048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB M. JOHNSON PHARM D.

Provider Business Mailing Address
First Line	:	196 SUNSET LAKE DR
Second Line	:
City	:	CHELSEA
State	:	AL
Zip	:	35043-3210
Country	:	US
Telephone Number	:	256-245-4446
Fax Number	:	256-245-4484

Provider Business Practice Location Address
First Line	:	264 W FORT WILLIAMS ST
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2432
Country	:	US
Telephone Number	:	256-245-4446
Fax Number	:	256-245-4484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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