Provider Demographics
NPI:1912993734
Name:JOHNSTON, MARC DOUGLAS (PHARMD,)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:DOUGLAS
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 1:15335 SE HIDDEN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7319
Mailing Address - Country:US
Mailing Address - Phone:775-846-8860
Mailing Address - Fax:
Practice Address - Street 1:15335 SE HIDDEN FALLS DRIVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:775-846-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH00127171835P0018X
NVNV140711835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV14071OtherNV BOARD OF PHARMACY LIC
NV941OtherCERTIFIED GERIATRIC PHARM
ORRPH0012717OtherPHARMACY LICENSE