Active NPI
Larry Dewayne Johnson, RPH
- Pharmacist
- Overton, TX
National Provider Identifier
1962081265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 30241
- Practice address
- 104 W Henderson St
Overton, TX 75684-1613 - Phone
- (903) 834-0154
- NPI assigned
- Apr 5, 2021
- Last updated
- Apr 5, 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 | 30241 | TX | Primary |
Addresses
Primary practice location
104 W Henderson St
Overton, TX 75684-1613
Mailing address
9921 Linden Lea Rd
Flint, TX 75762-6704
Phone (903) 312-1058
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Overton Pharmacy LLC | 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, 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": "1617580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617580800000",
"number": "1962081265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9921 LINDEN LEA RD",
"city": "FLINT",
"state": "TX",
"postal_code": "757626704",
"telephone_number": "903-312-1058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 W HENDERSON ST",
"city": "OVERTON",
"state": "TX",
"postal_code": "756841613",
"telephone_number": "903-834-0154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "LARRY",
"middle_name": "DEWAYNE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-05",
"last_updated": "2021-04-05",
"certification_date": "2021-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "30241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Overton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.