Provider Demographics
NPI:1356054480
Name:HUNT, ELDON (DPH)
Entity type:Individual
Prefix:DR
First Name:ELDON
Middle Name:
Last Name:HUNT
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 HIDDEN PRAIRIE CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9726
Mailing Address - Country:US
Mailing Address - Phone:405-205-1049
Mailing Address - Fax:
Practice Address - Street 1:10240 BROADWAY EXT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6309
Practice Address - Country:US
Practice Address - Phone:405-900-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist