Active NPI
Jerry Johnson, R.PH.
- Pharmacist
- Mill Spring, NC
National Provider Identifier
1629454897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9508
- Practice address
- 4004 Lake Adger Pkwy
Mill Spring, NC 28756-4800 - Phone
- (828) 899-8974
- Fax
- (828) 894-8975
- NPI assigned
- Aug 10, 2015
- Last updated
- Aug 10, 2015
- 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 | 9508 | SC | Primary |
Addresses
Primary practice location
4004 Lake Adger Pkwy
Mill Spring, NC 28756-4800
Mailing address
4004 Lake Adger Pkwy
Mill Spring, NC 28756-4800
Phone (828) 899-8974
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 420605 | Other | SC | NABP |
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 |
|---|---|---|---|
| 9508 | SC | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439164800000",
"number": "1629454897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4004 LAKE ADGER PKWY",
"city": "MILL SPRING",
"state": "NC",
"postal_code": "287564800",
"telephone_number": "828-899-8974",
"fax_number": "828-894-8975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4004 LAKE ADGER PKWY",
"city": "MILL SPRING",
"state": "NC",
"postal_code": "287564800",
"telephone_number": "828-899-8974",
"fax_number": "828-894-8975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JERRY",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-10",
"last_updated": "2015-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "9508",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP",
"identifier": "420605",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mill Spring, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.