=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750713673
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW DONALD HUNTINGTON PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2013
-----------------------------------------------------
Last Update Date | 08/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 S HIGHWAY 160
-----------------------------------------------------
City | PAHRUMP
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89048-4639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-751-8399
-----------------------------------------------------
Fax | 775-751-8864
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10220 HAVEN ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89183-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-991-1424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 18203
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------