=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417453812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN M HILS PHARM.D., BCPS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2018
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 907 N MORLEY ST
-----------------------------------------------------
City | MOBERLY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65270-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-263-4457
-----------------------------------------------------
Fax | 660-263-4456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 907 N MORLEY ST
-----------------------------------------------------
City | MOBERLY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65270-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-263-4457
-----------------------------------------------------
Fax | 660-263-4456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 3130814
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------