Provider Demographics
NPI:1811304165
Name:HINZE, KENDALL
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:HINZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 PARK VIEW DR
Mailing Address - Street 2:APT V-2
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2579
Mailing Address - Country:US
Mailing Address - Phone:717-602-6910
Mailing Address - Fax:
Practice Address - Street 1:241 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1514
Practice Address - Country:US
Practice Address - Phone:610-377-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448631183500000X
PARPI008518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RP448631OtherPA STATE BOARD OF PHARMACY
RPI008518OtherPA STATE BOARD OF PHARMACY