Provider Demographics
NPI:1386793339
Name:HUNTER, MARK (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HUNTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SCHUYLER ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14813-1015
Mailing Address - Country:US
Mailing Address - Phone:585-268-7287
Mailing Address - Fax:585-268-5677
Practice Address - Street 1:36 SCHUYLER ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-1015
Practice Address - Country:US
Practice Address - Phone:585-268-7287
Practice Address - Fax:585-268-5677
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02426135Medicaid
NY02426135Medicaid