Provider Demographics
NPI:1659945954
Name:HAHN, MAXWELL J (CPHT)
Entity Type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:J
Last Name:HAHN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N ATHERTON ST
Mailing Address - Street 2:CVS 1916
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2927
Mailing Address - Country:US
Mailing Address - Phone:814-234-4761
Mailing Address - Fax:814-234-0228
Practice Address - Street 1:1101 N ATHERTON ST
Practice Address - Street 2:CVS 1916
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2927
Practice Address - Country:US
Practice Address - Phone:814-234-4761
Practice Address - Fax:814-234-0228
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30149194183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician