1437445616 NPI number — DR. CARRIE DONIELLE HUSTON PHARMD

Table of content: DR. CARRIE DONIELLE HUSTON PHARMD (NPI 1437445616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437445616 NPI number — DR. CARRIE DONIELLE HUSTON PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSTON
Provider First Name:
CARRIE
Provider Middle Name:
DONIELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACOBS
Provider Other First Name:
CARRIE
Provider Other Middle Name:
DONIELLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437445616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9846 MISSION GORGE RD
Provider Second Line Business Mailing Address:
TARGET 1485
Provider Business Mailing Address City Name:
SANTEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92071-3834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-449-9682
Provider Business Mailing Address Fax Number:
619-449-9682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9846 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
TARGET 1485
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-449-9682
Provider Business Practice Location Address Fax Number:
619-449-9682
Provider Enumeration Date:
06/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  59231 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 17487 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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