Provider Demographics
NPI:1043387103
Name:JOHNSTON, DOUGLAS LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LEE
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15204 VICTORY WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8876
Mailing Address - Country:US
Mailing Address - Phone:209-532-8326
Mailing Address - Fax:209-533-9489
Practice Address - Street 1:1330 ENCLAVE PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2025
Practice Address - Country:US
Practice Address - Phone:800-222-2005
Practice Address - Fax:209-533-9489
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30420183500000X
WAPH00060969183500000X
NV16583183500000X
CO17051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist