=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164637567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUFF PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 10/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 E. WATER STREET
-----------------------------------------------------
City | BOYNE CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49712-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-582-6515
-----------------------------------------------------
Fax | 231-582-5008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 E. WATER STREET
-----------------------------------------------------
City | BOYNE CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49712-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-582-6515
-----------------------------------------------------
Fax | 231-582-5008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT LEE HUFF
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 231-582-6514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5301002182
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------