Ricky Lee Johnson Jr.
Individual provider Active NPI Pharmacist · Blountville, TN
NPI 1508459702 · NPPES record last updated Feb 18, 2021
Key facts
- NPI
- 1508459702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0000044724 (TN)
- Practice address
- 2340 Highway 394
Blountville, TN 37617-5319 - Phone
- (423) 323-1656
- NPI assigned
- Feb 18, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000044724 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co. | Current |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Locations
2340 Highway 394
Blountville, TN 37617
Phone (423) 323-1656
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0000044724 | TN | Yes |
Addresses
Primary practice location
2340 Highway 394
Blountville, TN 37617-5319
Mailing address
2340 Highway 394
Blountville, TN 37617-5319
Phone (423) 323-1656
Other providers in Blountville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.