Provider Demographics
NPI:1811598634
Name:HESS, MARK PATRICK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:PATRICK
Last Name:HESS
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 1:1109 SALEM BLVD
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-6835
Mailing Address - Country:US
Mailing Address - Phone:570-441-7614
Mailing Address - Fax:570-802-0581
Practice Address - Street 1:50 BRIAR CREEK PLZ
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4100
Practice Address - Country:US
Practice Address - Phone:570-802-0599
Practice Address - Fax:570-802-0581
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041562L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist