Healthcare Provider Details

I. General information

NPI: 1851840201
Provider Name (Legal Business Name): NATHAN HUNT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15055 VISTA RD STE 6
HELENDALE CA
92342-7717
US

IV. Provider business mailing address

19341 BEAR VALLEY RD STE 103
APPLE VALLEY CA
92308-5151
US

V. Phone/Fax

Practice location:
  • Phone: 760-983-2599
  • Fax: 760-983-2662
Mailing address:
  • Phone: 760-998-9503
  • Fax: 760-998-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateCA

VIII. Authorized Official

Name: JONATHAN HUNT BUDGE
Title or Position: OWNER
Credential: PHARMD
Phone: 760-983-2599