Healthcare Provider Details

I. General information

NPI: 1033125000
Provider Name (Legal Business Name): MARK L HYLWA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 STATE ROUTE 89
SENECA FALLS NY
13148-9413
US

IV. Provider business mailing address

ROUTE 89 BOX 2116
SENECA FALLS NY
13148
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-2311
  • Fax:
Mailing address:
  • Phone: 315-568-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number032532-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: