Healthcare Provider Details

I. General information

NPI: 1235307091
Provider Name (Legal Business Name): JULIAN BRINDLETON HUCKSTEP III RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 IRONBOUND RD EASTERN STATE HOSPITAL
WILLIAMSBURG VA
23188-2652
US

IV. Provider business mailing address

2721 PERSIMMON PL
WILLIAMSBURG VA
23185-8048
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-5327
  • Fax: 757-253-4521
Mailing address:
  • Phone: 757-564-7147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number0202006884
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: