Healthcare Provider Details

I. General information

NPI: 1245913128
Provider Name (Legal Business Name): BRET DONALD HUXTABLE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 MCCULLOCH BLVD N
LAKE HAVASU CITY AZ
86403-0961
US

IV. Provider business mailing address

3820 BREAKWATER DR
LAKE HAVASU CITY AZ
86406-4357
US

V. Phone/Fax

Practice location:
  • Phone: 928-855-9200
  • Fax:
Mailing address:
  • Phone: 406-274-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026597
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: