Provider Demographics
NPI:1215377064
Name:HUSTON, CAROL MAE (RPH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MAE
Last Name:HUSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 CANNON ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2441
Mailing Address - Country:US
Mailing Address - Phone:406-442-4591
Mailing Address - Fax:
Practice Address - Street 1:526 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2856
Practice Address - Country:US
Practice Address - Phone:406-442-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist