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NPI Code Detail

MEDICARE: DR. LARRY J HUETTL PHARMD

MEDICARE: DR. LARRY J HUETTL PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051.294917IL

General Provider Information

NPI Number : 1780966192
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY J HUETTL PHARMD
Provider Business Mailing Address
First Line : 1938 WILLIAMSBURG DR
Second Line :
City : STREAMWOOD
State : IL
Zip : 60107-1948
Country : US
Telephone Number : 847-501-1963
Fax Number :
Provider Business Practice Location Address
First Line : 933 N STATE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2842
Country : US
Telephone Number : 312-943-0671
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2011
Last Update Date : 09/12/2011

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