Provider Demographics
NPI:1295498350
Name:HIXENBAUGH, RENEE MARIE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:HIXENBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-2227
Mailing Address - Country:US
Mailing Address - Phone:724-775-1820
Mailing Address - Fax:724-775-0892
Practice Address - Street 1:111 W MADISON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2220
Practice Address - Country:US
Practice Address - Phone:724-775-1820
Practice Address - Fax:724-775-0892
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040355L183500000X
PARPI000457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist