Healthcare Provider Details

I. General information

NPI: 1881241594
Provider Name (Legal Business Name): JEFFREY ALAN HUFFMAN RPH., BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 W 7TH ST
JOPLIN MO
64801-3300
US

IV. Provider business mailing address

105 BRIAR MEADOW DR
CARL JUNCTION MO
64834-9787
US

V. Phone/Fax

Practice location:
  • Phone: 417-206-9205
  • Fax:
Mailing address:
  • Phone: 417-483-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number043914
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: