Provider Demographics
NPI:1609106343
Name:HUETTMANN, DEAN ELWOOD (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:ELWOOD
Last Name:HUETTMANN
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 1:100 N ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-5802
Mailing Address - Country:US
Mailing Address - Phone:281-472-3252
Mailing Address - Fax:281-427-1756
Practice Address - Street 1:100 N ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-5802
Practice Address - Country:US
Practice Address - Phone:281-472-3252
Practice Address - Fax:281-427-1756
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist