Healthcare Provider Details

I. General information

NPI: 1043208556
Provider Name (Legal Business Name): MICHAEL JOSEPH HORNER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W MAHONING ST
PUNXSUTAWNEY PA
15767-2017
US

IV. Provider business mailing address

1180 SCOTLAND AVENUE EXT
PUNXSUTAWNEY PA
15767-3069
US

V. Phone/Fax

Practice location:
  • Phone: 814-938-3077
  • Fax: 814-939-7383
Mailing address:
  • Phone: 814-938-3156
  • Fax: 814-939-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040950L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: