Provider Demographics
NPI:1346426939
Name:HESS, JONATHAN ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ALLEN
Last Name:HESS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 FULTON STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074
Mailing Address - Country:US
Mailing Address - Phone:315-564-6464
Mailing Address - Fax:315-564-6030
Practice Address - Street 1:450 FULTON STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:HANNIBAL
Practice Address - State:NY
Practice Address - Zip Code:13074
Practice Address - Country:US
Practice Address - Phone:315-564-6464
Practice Address - Fax:315-564-6030
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6605750001Medicare NSC