Healthcare Provider Details

I. General information

NPI: 1912418641
Provider Name (Legal Business Name): EDWARD HUH PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W MCDOWELL RD
AVONDALE AZ
85392-4803
US

IV. Provider business mailing address

263 S MOOREA DR
GILBERT AZ
85296-2143
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-5662
  • Fax:
Mailing address:
  • Phone: 480-620-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS012891
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: