Samuel Dale Huskey, PHARM. D.
Individual provider Active NPI Pharmacist · O Fallon, IL
NPI 1568068328 · NPPES record last updated Dec 8, 2020
Key facts
- NPI
- 1568068328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051303634 (IL)
- Practice address
- 704 Cambridge Blvd
O Fallon, IL 62269-1964 - Phone
- (618) 632-6920
- NPI assigned
- Dec 8, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051303634 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051303634 | IL | Yes |
Addresses
Primary practice location
704 Cambridge Blvd
O Fallon, IL 62269-1964
Mailing address
310 N 11TH St
De Soto, MO 63020-1616
Phone (314) 852-4272
Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.