Provider Demographics
NPI:1154502268
Name:HUESTIS, PHILIP CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:CHARLES
Last Name:HUESTIS
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 1:1550 VANN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-3359
Mailing Address - Country:US
Mailing Address - Phone:812-469-7435
Mailing Address - Fax:
Practice Address - Street 1:1550 VANN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-3359
Practice Address - Country:US
Practice Address - Phone:812-469-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015185A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist