Provider Demographics
NPI:1427507698
Name:HUFFAKER, GREGORY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:HUFFAKER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1642
Mailing Address - Country:US
Mailing Address - Phone:928-443-0300
Mailing Address - Fax:928-443-0500
Practice Address - Street 1:1044 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1642
Practice Address - Country:US
Practice Address - Phone:928-443-0300
Practice Address - Fax:928-443-0500
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist