Provider Demographics
NPI:1891068854
Name:HUEBNER, JOHN TAYLOR (RP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TAYLOR
Last Name:HUEBNER
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6570 S HERSHEY DICKENS RD
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:NE
Mailing Address - Zip Code:69143-4361
Mailing Address - Country:US
Mailing Address - Phone:308-368-7422
Mailing Address - Fax:
Practice Address - Street 1:1845 W A ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4534
Practice Address - Country:US
Practice Address - Phone:308-532-5539
Practice Address - Fax:308-532-3784
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist