Healthcare Provider Details

I. General information

NPI: 1700401296
Provider Name (Legal Business Name): KYLE ROBERT HEJMANOWSKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

IV. Provider business mailing address

111 FAIRWAY DR
DILLSBURG PA
17019-1551
US

V. Phone/Fax

Practice location:
  • Phone: 717-782-3338
  • Fax:
Mailing address:
  • Phone: 717-350-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS55223
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450901
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: