Provider Demographics
NPI:1245392844
Name:HUNT, MABEL ALLENE (RPH)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:ALLENE
Last Name:HUNT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 B VIRGINIA PLACE
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2510
Mailing Address - Country:US
Mailing Address - Phone:361-552-2600
Mailing Address - Fax:361-552-6039
Practice Address - Street 1:1 B VIRGINIA PL
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2510
Practice Address - Country:US
Practice Address - Phone:361-552-2600
Practice Address - Fax:361-552-6039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4568309OtherNABP