NPIMap

Organization Active NPI

Huttula Enterprises Inc

  • Community/Retail Pharmacy
  • McCleary, WA
National Provider Identifier
1124480074
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHAR.CF.60625079 Issued in WA
Legal business name
HUTTULA ENTERPRISES INC
Practice address
115 W Simpson Ave
McCleary, WA 98557
Phone
(360) 495-0700
Fax
(360) 495-0011
NPI assigned
Mar 21, 2016
Last updated
Nov 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tom Huttula
Title
Owner, President, Pic, Ao
Phone
(360) 495-0700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHAR.CF.60625079 WA Primary

Addresses

Primary practice location

115 W Simpson Ave
McCleary, WA 98557

Mailing address

PO Box 88
McCleary, WA 98557-0088
Phone (360) 495-0700

Other identifiers 2

IdentifierTypeStateIssuer
2056816MedicaidWA
2158869OtherPK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150925002547 WA Part B Supplier - Mass Immunization (Roster Biller Only) 1951429000 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elma, WA; McCleary, WA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Huttula Enterprises Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605139200000",
    "number": "1124480074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88",
            "city": "MCCLEARY",
            "state": "WA",
            "postal_code": "985570088",
            "telephone_number": "360-495-0700",
            "fax_number": "360-495-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W SIMPSON AVE",
            "city": "MCCLEARY",
            "state": "WA",
            "postal_code": "98557",
            "telephone_number": "360-495-0700",
            "fax_number": "360-495-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUTTULA ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-21",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "HUTTULA",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "OWNER, PRESIDENT, PIC, AO",
        "authorized_official_telephone_number": "360-495-0700"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.60625079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2056816",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158869",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McCleary, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.