Healthcare Provider Details

I. General information

NPI: 1285930529
Provider Name (Legal Business Name): ROBERT ANTHONY HOJNACKI R.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SPINNAKER BAY LN
LAKE WYLIE SC
29710-8841
US

IV. Provider business mailing address

115 SPINNAKER BAY LN
LAKE WYLIE SC
29710
US

V. Phone/Fax

Practice location:
  • Phone: 803-631-5117
  • Fax:
Mailing address:
  • Phone: 803-631-5117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11708
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: