Provider Demographics
NPI:1649300187
Name:THOMAS C JOHNSTON JR
Entity type:Organization
Organization Name:THOMAS C JOHNSTON JR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CAREY
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-261-7651
Mailing Address - Street 1:54 E KING ST
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-1308
Mailing Address - Country:US
Mailing Address - Phone:717-532-5812
Mailing Address - Fax:717-532-9265
Practice Address - Street 1:216 AUGHWICK RD
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8246
Practice Address - Country:US
Practice Address - Phone:717-261-7651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X
PAPP412103L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001017791Medicaid
2084853OtherPK
2084853OtherPK