Provider Demographics
NPI:1679173611
Name:HUNT, KEITH MCBRAYER (RPH)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:MCBRAYER
Last Name:HUNT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:KEITH
Other - Middle Name:MCBRAYER
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:630 BOSTIC SUNSHINE HWY
Mailing Address - Street 2:
Mailing Address - City:BOSTIC
Mailing Address - State:NC
Mailing Address - Zip Code:28018-9779
Mailing Address - Country:US
Mailing Address - Phone:479-721-3421
Mailing Address - Fax:
Practice Address - Street 1:630 BOSTIC SUNSHINE HWY
Practice Address - Street 2:
Practice Address - City:BOSTIC
Practice Address - State:NC
Practice Address - Zip Code:28018-9779
Practice Address - Country:US
Practice Address - Phone:479-721-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist