Provider Demographics
NPI:1235538794
Name:HUFFMAN, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 S 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6502
Mailing Address - Country:US
Mailing Address - Phone:602-323-0583
Mailing Address - Fax:602-323-2891
Practice Address - Street 1:7550 S 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6502
Practice Address - Country:US
Practice Address - Phone:602-323-0583
Practice Address - Fax:602-323-2891
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAS012306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist