Active NPI
Pamela Johnson
- Pharmacist
- Graham, TX
National Provider Identifier
1073167342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 41814
- Practice address
- 1229 State Highway 16 S
Graham, TX 76450-3809 - Phone
- (940) 549-3000
- NPI assigned
- Jul 25, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13286 | OK | |
| Pharmacist | 183500000X | 41814 | TX | Primary |
Addresses
Primary practice location
1229 State Highway 16 S
Graham, TX 76450-3809
Mailing address
618 W Live Oak St
Jacksboro, TX 76458-1659
Phone (940) 550-4527
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13286 | OK | MD | Pharmacist |
| 41814 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Supermarkets LLC | Past | Accepting new patients | |
| United Supermarkets LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Graham, TX
- NPI 1265695266
-
- Community/Retail Pharmacy
- Rio Rancho, NM
- NPI 1346061900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564012800000",
"number": "1073167342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "618 W LIVE OAK ST",
"city": "JACKSBORO",
"state": "TX",
"postal_code": "764581659",
"telephone_number": "940-550-4527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1229 STATE HIGHWAY 16 S",
"city": "GRAHAM",
"state": "TX",
"postal_code": "764503809",
"telephone_number": "940-549-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PAMELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-25",
"last_updated": "2019-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "13286",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "41814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Graham, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.