Provider Demographics
NPI:1871031039
Name:HENNETT, CANDY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CANDY
Middle Name:
Last Name:HENNETT
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 298
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-0298
Mailing Address - Country:US
Mailing Address - Phone:570-473-7506
Mailing Address - Fax:570-473-9336
Practice Address - Street 1:173 POINT TOWNSHIP DR
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-8889
Practice Address - Country:US
Practice Address - Phone:570-473-7506
Practice Address - Fax:570-473-9336
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040335T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist