Provider Demographics
NPI:1255838678
Name:HUBER, MICHELLE D (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:HUBER
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22620 GRENOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51108-8691
Mailing Address - Country:US
Mailing Address - Phone:712-898-1996
Mailing Address - Fax:
Practice Address - Street 1:4300 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1139
Practice Address - Country:US
Practice Address - Phone:712-898-1996
Practice Address - Fax:712-233-1123
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA181041835P1200X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE12625OtherPHARMACIST LICENSE
MN119535OtherPHARMACIST LICENSE
IA18104OtherREGISTERD PHARMACIST LICENSE