Healthcare Provider Details

I. General information

NPI: 1124985643
Provider Name (Legal Business Name): GREGORY HUNT TODD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GREG TODD CPHT

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 BRADY LN
BEREA KY
40403-8088
US

IV. Provider business mailing address

508 BRADY LN
BEREA KY
40403-8088
US

V. Phone/Fax

Practice location:
  • Phone: 859-582-9028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00390077
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: