Healthcare Provider Details

I. General information

NPI: 1144824723
Provider Name (Legal Business Name): JANIS HUFFMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 GEZON PKWY SW
WYOMING MI
49509-9397
US

IV. Provider business mailing address

165 WINDFLOWER ST NE
COMSTOCK PARK MI
49321-9592
US

V. Phone/Fax

Practice location:
  • Phone: 616-878-8110
  • Fax:
Mailing address:
  • Phone: 616-558-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024718
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: