Provider Demographics
NPI:1760253371
Name:JOHNSON, AUSTIN STEELE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:STEELE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2309
Mailing Address - Country:US
Mailing Address - Phone:406-293-3784
Mailing Address - Fax:
Practice Address - Street 1:1401 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2309
Practice Address - Country:US
Practice Address - Phone:406-293-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-101697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist