Healthcare Provider Details

I. General information

NPI: 1093022840
Provider Name (Legal Business Name): LANCE TONY HUNT PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6690 W UNION HILLS DR
GLENDALE AZ
85308-1011
US

IV. Provider business mailing address

16831 N 58TH ST #223
SCOTTSDALE AZ
85254-9227
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-5319
  • Fax:
Mailing address:
  • Phone: 801-597-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018095
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: