Healthcare Provider Details

I. General information

NPI: 1831200351
Provider Name (Legal Business Name): KURT MALCOLM JOHNSTON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6719
US

IV. Provider business mailing address

6 NATHAN DR
TOPSHAM ME
04086-1339
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax: 207-621-4843
Mailing address:
  • Phone: 207-623-8411
  • Fax: 207-621-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPR3757
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: