Provider Demographics
NPI:1114264157
Name:RECKENWALD, HILLARY ELAINE (RPH)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:ELAINE
Last Name:RECKENWALD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11667 BOYETTE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5531
Mailing Address - Country:US
Mailing Address - Phone:813-672-2744
Mailing Address - Fax:813-672-8854
Practice Address - Street 1:11667 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5531
Practice Address - Country:US
Practice Address - Phone:813-672-2744
Practice Address - Fax:813-672-8854
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist