Basic Information
Provider Information
NPI: 1518271527
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUFF
FirstName: ROBERT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3663 BRIARPARK DR
Address2:  
City: HOUSTON
State: TX
PostalCode: 770425205
CountryCode: US
TelephoneNumber: 7132683630
FaxNumber: 6238691717
Practice Location
Address1: 4720 BRYANT IRVIN RD
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761323604
CountryCode: US
TelephoneNumber: 8172949994
FaxNumber: 8173706459
Other Information
ProviderEnumerationDate: 08/02/2010
LastUpdateDate: 08/02/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X31488TXY Pharmacy Service ProvidersPharmacist 

No ID Information.


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