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General NPI Number Information
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NPI Number | 1710544010
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Entity Type | Individual
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Provider Name | JACKIE PAIGE JOHNSTON PHARMD, BCPS
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 55 PARK ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-5474
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Country | US
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Telephone | 203-558-0675
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Fax |
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Provider Business Mailing Address
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Address Line | 529 JEFFERSON ST APT 5
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City | HOBOKEN
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State | NJ
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Zip | 07030-2013
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Country | US
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Telephone | 203-558-0675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835C0205X
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Taxonomy Name | Critical Care Pharmacist
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License Number | 28RI03875000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1835C0205X
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Taxonomy Name | Critical Care Pharmacist
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License Number | PCT.0013301
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License Number State | CT
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