Provider Demographics
NPI:1528045382
Name:HUTH, MARK (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HUTH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 LOGGERS RD
Mailing Address - Street 2:
Mailing Address - City:GOODVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24095-2474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3416 WILLIAMSON RD NW
Practice Address - Street 2:WILLIAMSON RD PHARMACY
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-4051
Practice Address - Country:US
Practice Address - Phone:540-366-4481
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist