Provider Demographics
NPI:1043208556
Name:HORNER, MICHAEL JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:HORNER
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 1:1180 SCOTLAND AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-3069
Mailing Address - Country:US
Mailing Address - Phone:814-938-3156
Mailing Address - Fax:814-939-7383
Practice Address - Street 1:132 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2017
Practice Address - Country:US
Practice Address - Phone:814-938-3077
Practice Address - Fax:814-939-7383
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040950L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist