Provider Demographics
NPI:1437441177
Name:FREE, HUNTER ROBERTSON (RPH)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:ROBERTSON
Last Name:FREE
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:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-0645
Mailing Address - Country:US
Mailing Address - Phone:803-407-3108
Mailing Address - Fax:803-732-7298
Practice Address - Street 1:200 FRIARSGATE PLAZA
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-407-3108
Practice Address - Fax:803-732-7298
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist