Provider Demographics
NPI:1144824723
Name:HUFFMAN, JANIS (RPH)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WINDFLOWER ST NE
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9592
Mailing Address - Country:US
Mailing Address - Phone:616-558-3450
Mailing Address - Fax:
Practice Address - Street 1:1550 GEZON PKWY SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9397
Practice Address - Country:US
Practice Address - Phone:616-878-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist