Healthcare Provider Details

I. General information

NPI: 1306103882
Provider Name (Legal Business Name): MICHAEL THOMAS HUTTULA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W MAIN ST
ELMA WA
98541
US

IV. Provider business mailing address

PO BOX 1888
ELMA WA
98541-1888
US

V. Phone/Fax

Practice location:
  • Phone: 360-482-2442
  • Fax:
Mailing address:
  • Phone: 360-470-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60548608
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: