Healthcare Provider Details

I. General information

NPI: 1164720694
Provider Name (Legal Business Name): REBECCA HOHENFORST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 5TH AVE EXT
GLOVERSVILLE NY
12078-1820
US

IV. Provider business mailing address

1675 STATE HIGHWAY 29A
GLOVERSVILLE NY
12078-6244
US

V. Phone/Fax

Practice location:
  • Phone: 518-773-8449
  • Fax:
Mailing address:
  • Phone: 518-848-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054555
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: