Provider Demographics
NPI:1437445616
Name:HUSTON, CARRIE DONIELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:DONIELLE
Last Name:HUSTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:DONIELLE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9846 MISSION GORGE RD
Mailing Address - Street 2:TARGET 1485
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3834
Mailing Address - Country:US
Mailing Address - Phone:619-449-9682
Mailing Address - Fax:619-449-9682
Practice Address - Street 1:9846 MISSION GORGE RD
Practice Address - Street 2:TARGET 1485
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3834
Practice Address - Country:US
Practice Address - Phone:619-449-9682
Practice Address - Fax:619-449-9682
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59231183500000X
CO17487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist