MEDICARE: REBECCA HOHENFORST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	054555	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164720694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA HOHENFORST

Provider Business Mailing Address
First Line	:	1675 STATE HIGHWAY 29A
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-6244
Country	:	US
Telephone Number	:	518-848-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 5TH AVE EXT
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1820
Country	:	US
Telephone Number	:	518-773-8449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	03/08/2011

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