=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649035403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN ROBERT JOHNSTONE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2024
-----------------------------------------------------
Last Update Date | 02/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6655 ALVARADO RD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92120-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-229-3150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13861 N BUCCANEER WAY
-----------------------------------------------------
City | SUN CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85351-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-922-8464
-----------------------------------------------------
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 | RPH40575
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------