Organization
WILLIAM CARLYLE JOHNSON
Active
Other names
RIVERSIDE MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM CARLYLE JOHNSON D.PH. (OWNER PHARMACIST)
(931) 536-1414
Entity
Organization
Contact information
Practice address
710 MADISON ST, SUITE C, SHELBYVILLE, TN 37160-3519
(931) 536-1414
(931) 684-6999
Mailing address
710 MADISON ST, SUITE C, SHELBYVILLE, TN 37160-3519
(931) 536-1414
(931) 684-6999
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1455165
—
TN
Enumeration date
07/10/2007
Last updated
06/16/2008
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