Provider Demographics
NPI:1710516216
Name:HUNTER, JOHN KEFREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEFREN
Last Name:HUNTER
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 1:2323 OLD PLANK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1153
Mailing Address - Country:US
Mailing Address - Phone:618-826-2511
Mailing Address - Fax:618-826-3060
Practice Address - Street 1:324 W BROADWAY
Practice Address - Street 2:
Practice Address - City:STEELEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62288-1407
Practice Address - Country:US
Practice Address - Phone:618-965-3511
Practice Address - Fax:618-965-9526
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL831912704Medicaid