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General NPI Number Information
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NPI Number | 1760824932
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Entity Type | Individual
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Provider Name | SAMANTHA JO JOHNSTON
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Gender | Female
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 135 S PLUM ST
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City | FRUITA
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State | CO
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Zip | 81521-2524
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Country | US
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Telephone | 970-858-9508
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Fax |
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Provider Business Mailing Address
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Address Line | 618 COBBLESTONE CT
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City | CANON CITY
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State | CO
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Zip | 81212-2083
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19911
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License Number State | CO
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