Provider Demographics
NPI:1780285460
Name:HAWBECKER, KENDRA RENEE
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:RENEE
Last Name:HAWBECKER
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 1:1969 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3950
Mailing Address - Country:US
Mailing Address - Phone:570-329-3388
Mailing Address - Fax:570-329-2793
Practice Address - Street 1:1969 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3950
Practice Address - Country:US
Practice Address - Phone:570-329-3388
Practice Address - Fax:570-329-2793
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044565L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist