Healthcare Provider Details

I. General information

NPI: 1275880643
Provider Name (Legal Business Name): ANNA HUFENDICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2012
Last Update Date: 08/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W MAIN ST
BELLEVILLE IL
62223-3700
US

IV. Provider business mailing address

7637 STONEBRIDGE GOLF DR
MARYVILLE IL
62062-6465
US

V. Phone/Fax

Practice location:
  • Phone: 618-398-2100
  • Fax:
Mailing address:
  • Phone: 217-440-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.295718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: