Provider Demographics
NPI:1023575859
Name:HUISENGA, DANIEL JOE (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOE
Last Name:HUISENGA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4604
Mailing Address - Country:US
Mailing Address - Phone:515-441-8124
Mailing Address - Fax:515-441-8129
Practice Address - Street 1:3105 GRAND AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4604
Practice Address - Country:US
Practice Address - Phone:515-441-8124
Practice Address - Fax:515-441-8129
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist