Healthcare Provider Details

I. General information

NPI: 1063563930
Provider Name (Legal Business Name): HILLMAN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STATE ST
HILLMAN MI
49746-9511
US

IV. Provider business mailing address

601 STATE ST
HILLMAN MI
49746-9511
US

V. Phone/Fax

Practice location:
  • Phone: 989-742-3527
  • Fax: 989-742-3567
Mailing address:
  • Phone: 989-742-3527
  • Fax: 989-742-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301005816
License Number StateMI

VIII. Authorized Official

Name: MR. DAN L KANGAS
Title or Position: OWNER
Credential: RPH
Phone: 989-742-3527