Active NPI
Scott Allen Johnson, RPH
- Pharmacist
- East Peoria, IL
National Provider Identifier
1013293067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051035316
- Practice address
- 300 N Main St
East Peoria, IL 61611-2016 - Phone
- (309) 694-7661
- Fax
- (309) 694-8706
- NPI assigned
- Oct 21, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051035316 | IL | Primary |
Addresses
Primary practice location
300 N Main St
East Peoria, IL 61611-2016
Mailing address
612 Taylor St
Morton, IL 61550-1766
Phone (309) 266-9192
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051035316 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319155200000",
"number": "1013293067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 TAYLOR ST",
"city": "MORTON",
"state": "IL",
"postal_code": "615501766",
"telephone_number": "309-266-9192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N MAIN ST",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616112016",
"telephone_number": "309-694-7661",
"fax_number": "309-694-8706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "SCOTT",
"middle_name": "ALLEN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-21",
"last_updated": "2011-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051035316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.