Provider Demographics
NPI:1376123745
Name:JOHNSTON, DYLAN ROYCE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:ROYCE
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 STATION RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:ME
Mailing Address - Zip Code:04760-3327
Mailing Address - Country:US
Mailing Address - Phone:207-538-6353
Mailing Address - Fax:
Practice Address - Street 1:797 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2201
Practice Address - Country:US
Practice Address - Phone:207-760-9100
Practice Address - Fax:207-760-9191
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR71615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist