MEDICARE: CHRISTIE H HYLWA RPH CGP

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	33776	NY
2	1835P1200X	Pharmacotherapy Pharmacist	33776	NY
3	1835P1300X	Psychiatric Pharmacist	33776	NY

General Provider Information

NPI Number	:	1811982713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE H HYLWA RPH CGP

Provider Business Mailing Address
First Line	:	2116 ROUTE 89
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148
Country	:	US
Telephone Number	:	315-568-2311
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FORT HILL AVE
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1159
Country	:	US
Telephone Number	:	585-393-7318
Fax Number	:	585-393-8357

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/12/2007

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