Provider Demographics
NPI:1639790736
Name:JOHNSTON WILLIS, ANGELA DAWN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DAWN
Last Name:JOHNSTON WILLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 DAVIS CT APT 617
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-2469
Mailing Address - Country:US
Mailing Address - Phone:251-648-1595
Mailing Address - Fax:
Practice Address - Street 1:1825 4TH ST # M3262A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2350
Practice Address - Country:US
Practice Address - Phone:415-353-1154
Practice Address - Fax:415-476-6632
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA728021835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology