Provider Demographics
NPI:1730254723
Name:HAUTALA, CURTISS A (RPH)
Entity type:Individual
Prefix:
First Name:CURTISS
Middle Name:A
Last Name:HAUTALA
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 1:41465 STATE HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-4115
Mailing Address - Country:US
Mailing Address - Phone:218-885-1813
Mailing Address - Fax:
Practice Address - Street 1:202 2ND ST
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1112
Practice Address - Country:US
Practice Address - Phone:218-885-2613
Practice Address - Fax:218-885-1462
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2999183500000X
MN111845-4183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist