Healthcare Provider Details

I. General information

NPI: 1376891812
Provider Name (Legal Business Name): HARLAN M HUSTED PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO STREET COMMUNITY REGIONAL MED CTR - INPATIENT PHARMACY
FRESNO CA
93715
US

IV. Provider business mailing address

6737 N MILBURN AVE STE 160 PMB 38
FRESNO CA
93722-2141
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-6295
  • Fax: 559-459-7377
Mailing address:
  • Phone: 559-434-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number57579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: