Healthcare Provider Details

I. General information

NPI: 1881207561
Provider Name (Legal Business Name): MEKENSIE MARIE HUGGLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 LYCOMING CREEK RD
WILLIAMSPORT PA
17701-1206
US

IV. Provider business mailing address

480 E 5TH AVE APT 4
SOUTH WILLIAMSPORT PA
17702-7458
US

V. Phone/Fax

Practice location:
  • Phone: 570-327-9920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454817
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: