Active NPI
Jacob Charles Johnson, PHARMD
- Pharmacist
- Memphis, TN
National Provider Identifier
1306517743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 45553
- Practice address
- 3502 Park Ave
Memphis, TN 38111-5622 - Phone
- (901) 324-1050
- NPI assigned
- Sep 24, 2021
- Sex
- Male
- Sole proprietor
- No
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 | 45553 | TN | Primary |
Addresses
Primary practice location
3502 Park Ave
Memphis, TN 38111-5622
Mailing address
145 Riverwalk PL
Memphis, TN 38103-0846
Phone (502) 974-5417
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
- Doctor of Pharmacy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tennessee CVS Pharmacy, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632441600000",
"number": "1306517743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 RIVERWALK PL",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381030846",
"telephone_number": "502-974-5417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3502 PARK AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381115622",
"telephone_number": "901-324-1050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JACOB",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-24",
"last_updated": "2021-09-24",
"certification_date": "2021-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "45553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.