Healthcare Provider Details

I. General information

NPI: 1972852549
Provider Name (Legal Business Name): BRIAN L HUNT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST
SANTA FE NM
87505-4780
US

IV. Provider business mailing address

1691 GALISTEO ST
SANTA FE NM
87505-4780
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-9797
  • Fax: 505-982-3649
Mailing address:
  • Phone: 505-988-9797
  • Fax: 505-982-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007855
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: