Provider Demographics
NPI:1285916056
Name:HUELS, EDWIN ANDREW III (PHARM D)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:ANDREW
Last Name:HUELS
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14950 S SUFFOLK CT
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-1900
Mailing Address - Country:US
Mailing Address - Phone:708-828-0706
Mailing Address - Fax:
Practice Address - Street 1:7945 W 95TH ST
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2229
Practice Address - Country:US
Practice Address - Phone:708-599-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist