=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811304165
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDALL HINZE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2014
-----------------------------------------------------
Last Update Date | 07/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 N 1ST ST
-----------------------------------------------------
City | LEHIGHTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18235-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-377-4262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4460 PARK VIEW DR APT V-2
-----------------------------------------------------
City | SCHNECKSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18078-2579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-602-6910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP448631
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPI008518
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------