Provider Demographics
NPI:1063773000
Name:HUNT, SHELTON BAKER (PHARMD)
Entity type:Individual
Prefix:
First Name:SHELTON
Middle Name:BAKER
Last Name:HUNT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 STATION CT
Mailing Address - Street 2:APT. 405
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2950
Mailing Address - Country:US
Mailing Address - Phone:804-338-4339
Mailing Address - Fax:
Practice Address - Street 1:129 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2534
Practice Address - Country:US
Practice Address - Phone:864-297-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCI-6655183500000X
SC13845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist