Organization
KELLEY R JOHNSON, LLC
Active
Other names
Prescription Shoppe of Georgetown
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY RAY JOHNSON RPH (OWNER)
(843) 546-2222
Entity
Organization
Contact information
Practice address
1743 N FRASER ST, GEORGETOWN, SC 29440-6407
(843) 546-2222
(843) 527-8300
Mailing address
1743 N FRASER ST, GEORGETOWN, SC 29440-6407
(843) 546-2222
(843) 527-8300
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2164
SC
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2088930
PK
—
05
—
712092
—
SC
Enumeration date
08/18/2006
Last updated
01/18/2022
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