Provider Demographics
NPI:1053601948
Name:JOHNSTON, FLETCHER (PHARM D)
Entity type:Individual
Prefix:
First Name:FLETCHER
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 HWY 24
Mailing Address - Street 2:SUITE M
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2582
Mailing Address - Country:US
Mailing Address - Phone:252-726-0279
Mailing Address - Fax:
Practice Address - Street 1:278 HWY 24
Practice Address - Street 2:SUITE M
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2582
Practice Address - Country:US
Practice Address - Phone:252-726-0279
Practice Address - Fax:252-726-0792
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14910OtherNCBOP