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General NPI Number Information
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NPI Number | 1245913128
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Entity Type | Individual
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Provider Name | BRET DONALD HUXTABLE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 1650 MCCULLOCH BLVD N
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-0961
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Country | US
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Telephone | 928-855-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 BREAKWATER DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-4357
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Country | US
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Telephone | 406-274-6911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S026597
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License Number State | AZ
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