Provider Demographics
NPI:1861106080
Name:HOGAN, HUNTER JOE III (DPH)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:JOE
Last Name:HOGAN
Suffix:III
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 1:10120 BROADWAY EXTENSION
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114
Mailing Address - Country:US
Mailing Address - Phone:405-640-7545
Mailing Address - Fax:405-730-8069
Practice Address - Street 1:10120 BROADWAY EXTENSION
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-640-7545
Practice Address - Fax:405-730-8069
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist