1194844126 NPI number — CAROL M JOHNSON PHARMACIST

Table of content: CAROL M JOHNSON PHARMACIST (NPI 1194844126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194844126 NPI number — CAROL M JOHNSON PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CAROL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194844126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S BLISS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUMAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79029-4434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-935-2333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S BLISS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79029-4434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-935-2333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  16435 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X , with the licence number: 02472 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16435 . This is a "PERSONAL PHARMACY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 02472 . This is a "PHARMACY STORE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 143922 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20002809 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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