Provider Demographics
NPI:1699010272
Name:JOHNSTON, MORRIS RAY
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:RAY
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 WOODSPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-0903
Mailing Address - Country:US
Mailing Address - Phone:870-972-8310
Mailing Address - Fax:870-972-1949
Practice Address - Street 1:1807 WOODSPRINGS RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-0903
Practice Address - Country:US
Practice Address - Phone:870-972-8310
Practice Address - Fax:870-972-1949
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist