Healthcare Provider Details

I. General information

NPI: 1528539103
Provider Name (Legal Business Name): ANTHONY GENE HURT PHARMD, MLS(ASCP)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LN STE 101
HAZARD KY
41701-9524
US

IV. Provider business mailing address

101 TOWN AND COUNTRY LN STE 101
HAZARD KY
41701-9524
US

V. Phone/Fax

Practice location:
  • Phone: 606-435-0460
  • Fax: 606-435-0461
Mailing address:
  • Phone: 606-435-0460
  • Fax: 606-435-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number235118
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number013617
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: