MEDICARE: LEE H JOHNSTON INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	3476	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3416016	OTHER	NC	NABP

General Provider Information

NPI Number	:	1255315909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE H JOHNSTON INC.

Provider Business Mailing Address
First Line	:	100 PARK AVE
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4027
Country	:	US
Telephone Number	:	919-776-9715
Fax Number	:	919-775-1360

Provider Business Practice Location Address
First Line	:	100 PARK AVE
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4027
Country	:	US
Telephone Number	:	919-776-9715
Fax Number	:	919-775-1360

Authorized Official
Title or Position	:	PRESIDENT/MANAGING PHARMACIST
Name	:	WILLIAM S CAMERON
Credential	:	RPH
Telephone Number	:	919-776-9715

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	09/23/2014

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