Mayberry Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

08125 Issued in NC

Legal business name

MAYBERRY PHARMACY

Practice address

933 Old Rockford St
Suite 3
Mount Airy, NC 27030-5356

Phone

(336) 789-0424

Fax

(336) 789-0157

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Wallace Allen Johnson Jr.NPI 1659480838

Title

Owner

Phone

(336) 789-0424

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Wallace Allen Johnson Jr.

  • Pharmacist
  • Mount Airy, NC
  • NPI 1659480838
  NPD (past) Authorized official

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891804084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 OLD ROCKFORD ST",
            "address_2": "SUITE 3",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270305356",
            "telephone_number": "336-789-0424",
            "fax_number": "336-789-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 OLD ROCKFORD ST",
            "address_2": "SUITE 3",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270305356",
            "telephone_number": "336-789-0424",
            "fax_number": "336-789-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYBERRY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-789-0424",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "08125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Kennedy Martin, PA-C
• Jennifer L Martin, CF-SLP
• Kristi Massey, FNP-C
• Leann Massie, NP
• Timothy G. Matthews, RPH
• Madeline Mayfield
• Georges Mazima
• Mariah Mercedes McClendon, RN
• Jarren McCowan, PHARMD
• Edward L. McDowell, PA-C

• Community/Retail Pharmacy in Mount Airy, NC
• Providers in Mount Airy, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.