Provider Demographics
NPI:1750630273
Name:NATHAN HUNT LLC
Entity Type:Organization
Organization Name:NATHAN HUNT LLC
Other - Org Name:JONATHAN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-983-2599
Mailing Address - Street 1:19341 BEAR VALLEY RD
Mailing Address - Street 2:STE 103
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-5151
Mailing Address - Country:US
Mailing Address - Phone:760-983-2599
Mailing Address - Fax:760-983-2662
Practice Address - Street 1:19341 BEAR VALLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5152
Practice Address - Country:US
Practice Address - Phone:760-983-2599
Practice Address - Fax:760-983-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY509413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136836OtherPK