Healthcare Provider Details

I. General information

NPI: 1962119818
Provider Name (Legal Business Name): JOHNATHON HURT PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 VILLAGE LN
HAZARD KY
41701-9408
US

IV. Provider business mailing address

476 REED HURT RD
CAMPTON KY
41301-8011
US

V. Phone/Fax

Practice location:
  • Phone: 606-435-2363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: