Provider Demographics
NPI:1245913128
Name:HUXTABLE, BRET DONALD (PHARMD)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:DONALD
Last Name:HUXTABLE
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 1:3820 BREAKWATER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-4357
Mailing Address - Country:US
Mailing Address - Phone:406-274-6911
Mailing Address - Fax:
Practice Address - Street 1:1650 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0961
Practice Address - Country:US
Practice Address - Phone:928-855-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist