Provider Demographics
NPI:1053691543
Name:HUECHTEMAN, MARCIA ANN (RPH)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
Last Name:HUECHTEMAN
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 1:4085 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2181
Mailing Address - Country:US
Mailing Address - Phone:563-332-0631
Mailing Address - Fax:
Practice Address - Street 1:830 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4101
Practice Address - Country:US
Practice Address - Phone:563-355-5345
Practice Address - Fax:563-355-6908
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist