Provider Demographics
NPI:1215260120
Name:HUANTE, JOSEPH M (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:HUANTE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S COMMERCE ST
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA368580Medicaid
CA1215260120OtherNPI
CAPHA368580Medicaid