Provider Demographics
NPI:1013512755
Name:PRICE, HUNTER BLAINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HUNTER
Middle Name:BLAINE
Last Name:PRICE
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 1:206 SNAPDRAGON ST
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-2504
Mailing Address - Country:US
Mailing Address - Phone:731-267-3137
Mailing Address - Fax:
Practice Address - Street 1:915 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2330
Practice Address - Country:US
Practice Address - Phone:618-351-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020030194183500000X
TN44203183500000X
IL051303703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist