# KELLEY R JOHNSON, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Prescription Shoppe of Georgetown
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215041298
- **Authorized official:** KELLEY RAY JOHNSON RPH (OWNER)
- **Authorized official phone:** (843) 546-2222

## Contact information

- **Practice address:** 1743 N FRASER ST, GEORGETOWN, SC 29440-6407
- **Practice address phone:** (843) 546-2222
- **Practice address fax:** (843) 527-8300
- **Mailing address:** 1743 N FRASER ST, GEORGETOWN, SC 29440-6407
- **Mailing address phone:** (843) 546-2222
- **Mailing address fax:** (843) 527-8300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 2164 | SC | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 01/18/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2088930 | PK | — |
| 05 | — | 712092 | — | SC |