Healthcare Provider Details

I. General information

NPI: 1164423158
Provider Name (Legal Business Name): SAMUEL DALTON HUBLER PHARM.D., MSHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

IV. Provider business mailing address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-5200
  • Fax:
Mailing address:
  • Phone: 509-525-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15163
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number15163
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: