Provider Demographics
NPI:1407451024
Name:JOHNSTON, DEVEN SPELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEVEN
Middle Name:SPELL
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COLONY CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7696
Mailing Address - Country:US
Mailing Address - Phone:601-605-1348
Mailing Address - Fax:
Practice Address - Street 1:110 COLONY CROSSING WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7696
Practice Address - Country:US
Practice Address - Phone:601-605-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist