Healthcare Provider Details

I. General information

NPI: 1821182700
Provider Name (Legal Business Name): HAUTEKEET INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N CURRY ST
CARSON CITY NV
89703-3975
US

IV. Provider business mailing address

1007 N CURRY ST
CARSON CITY NV
89703-3975
US

V. Phone/Fax

Practice location:
  • Phone: 775-841-1400
  • Fax: 775-841-1447
Mailing address:
  • Phone: 775-841-1400
  • Fax: 775-841-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHC01108
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HAUTEKEET
Title or Position: OWNER
Credential: PHD RPH
Phone: 775-841-1400