Provider Demographics
NPI:1083028260
Name:HUNTER, MARY GAILAND (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GAILAND
Last Name:HUNTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 6TH ST N
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4242
Mailing Address - Country:US
Mailing Address - Phone:575-838-1426
Mailing Address - Fax:575-838-1429
Practice Address - Street 1:700 6TH ST N
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4242
Practice Address - Country:US
Practice Address - Phone:575-838-1426
Practice Address - Fax:575-838-1429
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist