Provider Demographics
NPI:1437558889
Name:HUFFMYER, BOBBY JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:JOHN
Last Name:HUFFMYER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:HUFFMYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:4600 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-8603
Mailing Address - Country:US
Mailing Address - Phone:505-564-9195
Mailing Address - Fax:
Practice Address - Street 1:4600 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8603
Practice Address - Country:US
Practice Address - Phone:505-564-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00003026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist