Provider Demographics
NPI:1568752632
Name:HIBERNIK, SUSAN MARY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:HIBERNIK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 TEDS WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7219
Mailing Address - Country:US
Mailing Address - Phone:814-695-2420
Mailing Address - Fax:
Practice Address - Street 1:600 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4802
Practice Address - Country:US
Practice Address - Phone:814-943-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038267L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist