Provider Demographics
NPI:1629560628
Name:HUFFORD, CARLOS
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:HUFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 1ST AVE APT E21H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3924
Mailing Address - Country:US
Mailing Address - Phone:312-560-2887
Mailing Address - Fax:
Practice Address - Street 1:626 1ST AVE APT E21H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3924
Practice Address - Country:US
Practice Address - Phone:312-560-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236695183500000X
IL051295855183500000X
NY064024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty