Healthcare Provider Details

I. General information

NPI: 1932541513
Provider Name (Legal Business Name): DAVID PAUL HUHTELIN PHARMD, BCCCP, BCEMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

IV. Provider business mailing address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

V. Phone/Fax

Practice location:
  • Phone: 708-955-6365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21962
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number7151255
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License NumberB14100576
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051297946
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: