Provider Demographics
NPI:1043972748
Name:HIXSON, MARYANN MALAY
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:MALAY
Last Name:HIXSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BUFFALO PLZ
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-8301
Mailing Address - Country:US
Mailing Address - Phone:724-294-2802
Mailing Address - Fax:724-294-2820
Practice Address - Street 1:100 BUFFALO PLZ
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-8301
Practice Address - Country:US
Practice Address - Phone:724-294-2802
Practice Address - Fax:724-294-7282
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031851L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist