Provider Demographics
NPI:1558641027
Name:HEBDA, JOHN J (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:HEBDA
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 1:11932 HOMESTEAD HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9214
Mailing Address - Country:US
Mailing Address - Phone:219-365-2948
Mailing Address - Fax:219-365-2948
Practice Address - Street 1:11932 HOMESTEAD HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9214
Practice Address - Country:US
Practice Address - Phone:219-365-2948
Practice Address - Fax:219-365-2948
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014044A183500000X
IL051.032039183500000X
FLPS34006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist