Provider Demographics
NPI:1356688063
Name:JOHNSTON, KAREN (R PH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAUREL CANYON VILLAGE CIR
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4469
Mailing Address - Country:US
Mailing Address - Phone:770-479-3711
Mailing Address - Fax:770-479-3777
Practice Address - Street 1:15 LAUREL CANYON VILLAGE CIR
Practice Address - Street 2:SUITE 118
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4469
Practice Address - Country:US
Practice Address - Phone:770-479-3711
Practice Address - Fax:770-479-3777
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist