Provider Demographics
NPI:1003249574
Name:JOHNSTON, BRUCE DALTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DALTON
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7236
Mailing Address - Country:US
Mailing Address - Phone:814-234-8771
Mailing Address - Fax:
Practice Address - Street 1:335 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7236
Practice Address - Country:US
Practice Address - Phone:814-234-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP024963L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist