Healthcare Provider Details

I. General information

NPI: 1295917565
Provider Name (Legal Business Name): MR. LANCE HUSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 BROADWAY
SEATTLE WA
98122-3854
US

IV. Provider business mailing address

1407 BROADWAY
SEATTLE WA
98122-3854
US

V. Phone/Fax

Practice location:
  • Phone: 206-726-3495
  • Fax: 206-726-3498
Mailing address:
  • Phone: 206-726-3495
  • Fax: 206-726-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00042003
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: