Healthcare Provider Details

I. General information

NPI: 1801019799
Provider Name (Legal Business Name): DENNIS DEAN HINS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25527 MAIN STREET
NISSWA MN
56468-0200
US

IV. Provider business mailing address

PO BOX 200
NISSWA MN
56468-0200
US

V. Phone/Fax

Practice location:
  • Phone: 218-963-7525
  • Fax: 218-963-4722
Mailing address:
  • Phone: 218-963-7525
  • Fax: 218-963-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberMN12063
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: