Provider Demographics
NPI:1669074696
Name:JOHNSTON, SCOTT ALEXANDER (RPH, CSP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALEXANDER
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:RPH, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-7348
Mailing Address - Country:US
Mailing Address - Phone:214-616-4371
Mailing Address - Fax:
Practice Address - Street 1:9330 LBJ FWY STE 1300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3436
Practice Address - Country:US
Practice Address - Phone:888-777-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist