Healthcare Provider Details

I. General information

NPI: 1750447025
Provider Name (Legal Business Name): HUNT CLUB PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S HUNT CLUB BLVD STE 1001
APOPKA FL
32703-4947
US

IV. Provider business mailing address

425 S HUNT CLUB BLVD STE 1001
APOPKA FL
32703-4947
US

V. Phone/Fax

Practice location:
  • Phone: 407-389-6094
  • Fax: 407-389-6097
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22440
License Number StateFL

VIII. Authorized Official

Name: CHRISTIAN CHABAN
Title or Position: OWNER
Credential:
Phone: 407-463-5848