Healthcare Provider Details

I. General information

NPI: 1346426939
Provider Name (Legal Business Name): JONATHAN ALLEN HESS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 FULTON STREET SUITE 300
HANNIBAL NY
13074
US

IV. Provider business mailing address

450 FULTON STREET SUITE 300
HANNIBAL NY
13074
US

V. Phone/Fax

Practice location:
  • Phone: 315-564-6464
  • Fax: 315-564-6030
Mailing address:
  • Phone: 315-564-6464
  • Fax: 315-564-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: