Provider Demographics
NPI:1841585460
Name:HUSTON, SALLY ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANN
Last Name:HUSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1449
Mailing Address - Country:US
Mailing Address - Phone:937-233-4133
Mailing Address - Fax:937-401-5464
Practice Address - Street 1:5700 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1449
Practice Address - Country:US
Practice Address - Phone:937-233-4133
Practice Address - Fax:937-401-5464
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2013-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03218133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist