Provider Demographics
NPI:1568068328
Name:HUSKEY, SAMUEL DALE (PHARM D)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DALE
Last Name:HUSKEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-1616
Mailing Address - Country:US
Mailing Address - Phone:314-852-4272
Mailing Address - Fax:
Practice Address - Street 1:704 CAMBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1964
Practice Address - Country:US
Practice Address - Phone:618-632-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist