Provider Demographics
NPI:1568052769
Name:HILDEBRAN, SUSAN ANNETTE (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNETTE
Last Name:HILDEBRAN
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:SHEAKLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16151-0105
Mailing Address - Country:US
Mailing Address - Phone:724-699-2878
Mailing Address - Fax:724-450-7062
Practice Address - Street 1:631 N BROAD STREET EXT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4603
Practice Address - Country:US
Practice Address - Phone:724-450-7060
Practice Address - Fax:724-450-7062
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039015L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist