MEDICARE: DAVID P HILLGOTH PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.293223	IL

General Provider Information

NPI Number	:	1528395837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID P HILLGOTH PHARM.D.

Provider Business Mailing Address
First Line	:	5324 N OKETO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-1761
Country	:	US
Telephone Number	:	773-430-6079
Fax Number	:

Provider Business Practice Location Address
First Line	:	5324 N OKETO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-1761
Country	:	US
Telephone Number	:	773-430-6079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	11/06/2009

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