Provider Demographics
NPI:1710572425
Name:HUNT, GLENDA MICHELLE (CPHT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:MICHELLE
Last Name:HUNT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BOULDER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-2317
Mailing Address - Country:US
Mailing Address - Phone:404-934-5752
Mailing Address - Fax:
Practice Address - Street 1:2105 BARRETT PARK DR NW STE 101
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7080
Practice Address - Country:US
Practice Address - Phone:678-797-9067
Practice Address - Fax:678-797-9066
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC000012183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician