Healthcare Provider Details

I. General information

NPI: 1962403592
Provider Name (Legal Business Name): JOHNSTON DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N GRAND ST
CLARENCE MO
63437-1604
US

IV. Provider business mailing address

PO BOX 96
CLARENCE MO
63437-0096
US

V. Phone/Fax

Practice location:
  • Phone: 660-699-2432
  • Fax: 660-699-3873
Mailing address:
  • Phone: 660-699-2432
  • Fax: 660-699-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number004095
License Number StateMO

VIII. Authorized Official

Name: JAMES JOHNSTON
Title or Position: OWNER / PRESIDENT
Credential: PHARMD
Phone: 660-699-2432