Healthcare Provider Details

I. General information

NPI: 1457502742
Provider Name (Legal Business Name): MARCIA LUELLA HUFFORD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA HONSBERGER HUFFORD RPH

II. Dates (important events)

Enumeration Date: 10/04/2008
Last Update Date: 10/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W MAIN ST
CRESTLINE OH
44827-1430
US

IV. Provider business mailing address

145 W MAIN ST
CRESTLINE OH
44827-1430
US

V. Phone/Fax

Practice location:
  • Phone: 419-683-2512
  • Fax: 419-683-6322
Mailing address:
  • Phone: 419-683-2512
  • Fax: 419-683-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03217884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: