=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376123745
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DYLAN ROYCE JOHNSTON PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2021
-----------------------------------------------------
Last Update Date | 08/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 797 MAIN ST
-----------------------------------------------------
City | PRESQUE ISLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04769-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-760-9100
-----------------------------------------------------
Fax | 207-760-9191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 STATION RD
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04760-3327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-538-6353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PR71615
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------