Provider Demographics
NPI:1780952333
Name:JOHNSTON, DEREK ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ANDREW
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8783 CARRIAGE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8980
Mailing Address - Country:US
Mailing Address - Phone:901-388-6118
Mailing Address - Fax:
Practice Address - Street 1:6310 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4734
Practice Address - Country:US
Practice Address - Phone:901-680-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist