Healthcare Provider Details

I. General information

NPI: 1982219218
Provider Name (Legal Business Name): DWIGHT HUSELAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 WELSH RD
WILLOW GROVE PA
19090-2900
US

IV. Provider business mailing address

3925 WELSH RD
WILLOW GROVE PA
19090-2900
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-4709
  • Fax: 215-657-9728
Mailing address:
  • Phone: 215-657-4709
  • Fax: 215-657-4728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH239664
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: