Provider Demographics
NPI:1225112444
Name:HUNTER, BRADY A (RPH)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:A
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 1:3981 ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:RICEVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50466-8001
Mailing Address - Country:US
Mailing Address - Phone:641-985-2124
Mailing Address - Fax:
Practice Address - Street 1:120 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:RICEVILLE
Practice Address - State:IA
Practice Address - Zip Code:50466-0272
Practice Address - Country:US
Practice Address - Phone:641-985-4114
Practice Address - Fax:641-985-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist