Individual provider Active NPI

Marc Philip Johnson, RPH

  • Pharmacist
  • Brockton, MA
National Provider Identifier
1851676399
Registry record updated Oct 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
23277 Issued in MA
Practice address
1101 Main St
Brockton, MA 02301-6828
Phone
(508) 580-3164
Fax
(508) 580-3270
NPI assigned
Oct 17, 2011
Last updated
Oct 17, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 23277 MA Primary

Addresses

Primary practice location

1101 Main St
Brockton, MA 02301-6828

Mailing address

110 Old Farm Rd
Bridgewater, MA 02324-3451
Phone (508) 697-2591

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

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Eastern Co Inc Past Accepting new patients
Walgreen Eastern Co Inc 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1851676399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 OLD FARM RD",
            "city": "BRIDGEWATER",
            "state": "MA",
            "postal_code": "023243451",
            "telephone_number": "508-697-2591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023016828",
            "telephone_number": "508-580-3164",
            "fax_number": "508-580-3270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARC",
        "middle_name": "PHILIP",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-17",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "23277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.