Provider Demographics
NPI:1275676173
Name:HUNTSMAN, JOSEPH T (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:T
Last Name:HUNTSMAN
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 1:2106 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-5412
Mailing Address - Country:US
Mailing Address - Phone:423-586-0721
Mailing Address - Fax:423-587-5419
Practice Address - Street 1:2106 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-5412
Practice Address - Country:US
Practice Address - Phone:423-586-0721
Practice Address - Fax:423-587-5419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454167Medicaid
TN4419809OtherNCPDP