Healthcare Provider Details

I. General information

NPI: 1477679900
Provider Name (Legal Business Name): CARL GEORGE HUEBBERS JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BANK ST
LE ROY NY
14482-1414
US

IV. Provider business mailing address

129 LOYALIST AVE
ROCHESTER NY
14624-4966
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-6700
  • Fax:
Mailing address:
  • Phone: 585-247-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number039063
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: