Healthcare Provider Details

I. General information

NPI: 1720691355
Provider Name (Legal Business Name): HENRY A HUANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 10/05/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PULLMAN ST BLDG B
LIVERMORE CA
94551-9756
US

IV. Provider business mailing address

300 PULLMAN ST BLDG B
LIVERMORE CA
94551-9756
US

V. Phone/Fax

Practice location:
  • Phone: 925-294-7138
  • Fax:
Mailing address:
  • Phone: 925-294-7138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: