Provider Demographics
NPI:1730124058
Name:JOSEPH HUANTE
Entity Type:Organization
Organization Name:JOSEPH HUANTE
Other - Org Name:WATERFRONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-463-7777
Mailing Address - Street 1:123 S COMMERCE ST
Mailing Address - Street 2:STE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2837
Mailing Address - Country:US
Mailing Address - Phone:209-463-7777
Mailing Address - Fax:209-463-2206
Practice Address - Street 1:123 S COMMERCE ST
Practice Address - Street 2:STE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2837
Practice Address - Country:US
Practice Address - Phone:209-463-7777
Practice Address - Fax:209-463-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY368583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0578368OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA368580Medicaid
CA1730124058OtherNPI
CAPHA368580Medicaid