Provider Demographics
NPI:1255315909
Name:LEE H JOHNSTON INC.
Entity Type:Organization
Organization Name:LEE H JOHNSTON INC.
Other - Org Name:MEDICINE PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-776-9715
Mailing Address - Street 1:100 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4027
Mailing Address - Country:US
Mailing Address - Phone:919-776-9715
Mailing Address - Fax:919-775-1360
Practice Address - Street 1:100 PARK AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4027
Practice Address - Country:US
Practice Address - Phone:919-776-9715
Practice Address - Fax:919-775-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3476333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0535138Medicaid
NC3416016OtherNABP
NC3416016OtherNABP