Provider Demographics
NPI:1033125000
Name:HYLWA, MARK L (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:HYLWA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 89
Mailing Address - Street 2:BOX 2116
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148
Mailing Address - Country:US
Mailing Address - Phone:315-568-2311
Mailing Address - Fax:
Practice Address - Street 1:2116 STATE ROUTE 89
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-9413
Practice Address - Country:US
Practice Address - Phone:315-568-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032532-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist