Provider Demographics
NPI:1053400606
Name:JOHNSONS PHARMACY LLC
Entity type:Organization
Organization Name:JOHNSONS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KACI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHRM D
Authorized Official - Phone:850-567-2163
Mailing Address - Street 1:219 N WAUKESHA ST
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-2245
Mailing Address - Country:US
Mailing Address - Phone:850-547-2163
Mailing Address - Fax:850-547-5730
Practice Address - Street 1:219 N WAUKESHA ST
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-2245
Practice Address - Country:US
Practice Address - Phone:850-547-2163
Practice Address - Fax:850-547-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH177543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011896OtherPK
FL113890200Medicaid
4278730001Medicare NSC