Healthcare Provider Details

I. General information

NPI: 1205124476
Provider Name (Legal Business Name): AUTUMN LEIGH HUFFINES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 W WEBB AVE
BURLINGTON NC
27215
US

IV. Provider business mailing address

2017 W WEBB AVE
BURLINGTON NC
27217-1063
US

V. Phone/Fax

Practice location:
  • Phone: 336-221-8861
  • Fax: 336-221-8866
Mailing address:
  • Phone: 336-221-8861
  • Fax: 336-221-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12614
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: