Provider Demographics
NPI:1336495241
Name:HUFFER, JUSTIN VINES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:VINES
Last Name:HUFFER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 N HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-9600
Mailing Address - Country:US
Mailing Address - Phone:480-558-5127
Mailing Address - Fax:
Practice Address - Street 1:754 N HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-9600
Practice Address - Country:US
Practice Address - Phone:480-558-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist