Provider Demographics
NPI:1750447025
Name:HUNT CLUB PHARMACY
Entity Type:Organization
Organization Name:HUNT CLUB PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-463-5848
Mailing Address - Street 1:425 S HUNT CLUB BLVD
Mailing Address - Street 2:STE 1001
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 S HUNT CLUB BLVD
Practice Address - Street 2:STE 1001
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4947
Practice Address - Country:US
Practice Address - Phone:407-389-6094
Practice Address - Fax:407-389-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH224403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1024102OtherOTHER ID NUMBER-COMMERCIAL NUMBER