Kelley R Johnson, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2164 Issued in SC

Legal business name

KELLEY R JOHNSON, LLC

Practice address

1743 N Fraser St
Georgetown, SC 29440-6407

Phone

(843) 546-2222

Fax

(843) 527-8300

NPI assigned

Aug 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelley Ray Johnson, RPHNPI 1407173636

Title

Owner

Phone

(843) 546-2222

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Prescription Shoppe of Georgetown Doing business as

Medicare fee-for-service enrollment

Enrolled in SC2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelley Ray Johnson, R.PH.

  • Pharmacist
  • Liberty, SC
  • NPI 1407173636
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1215041298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1743 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294406407",
            "telephone_number": "843-546-2222",
            "fax_number": "843-527-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1743 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294406407",
            "telephone_number": "843-546-2222",
            "fax_number": "843-527-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLEY R JOHNSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-546-2222",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "2164",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "712092",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2088930",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prescription Shoppe of Georgetown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenneth Wesley Jordan, DC
• Joseph and Berson LLC
• Joseph and Joseph P.a.
• John Anthony Joseph Jr., D.M.D.
• Timothy Joseph, D.M.D.
• Faron J Kemp, M.D.
• Wendy Lynn Kiggins, RD
• Victoria Lynn Kiningham, CNM
• Christopher Bret Kirtley
• Jo-Anne S. Klein, M.D.

• Community/Retail Pharmacy in Georgetown, SC
• Providers in Georgetown, SC by specialty
• Community/Retail Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.