Healthcare Provider Details

I. General information

NPI: 1689196685
Provider Name (Legal Business Name): BRYAN HUFFSTETLER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 FALLS AVE
GRANITE FALLS NC
28630-1519
US

IV. Provider business mailing address

21 FALLS AVE
GRANITE FALLS NC
28630-1519
US

V. Phone/Fax

Practice location:
  • Phone: 828-396-2144
  • Fax: 828-396-9561
Mailing address:
  • Phone: 828-396-2144
  • Fax: 828-396-9561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26144
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: