MEDICARE: MITZI HIDAKA

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	051.290070	IL

General Provider Information

NPI Number	:	1043619430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITZI HIDAKA

Provider Business Mailing Address
First Line	:	1780 WALL ST
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-5790
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 WALL ST
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-5790
Country	:	US
Telephone Number	:	847-634-5000
Fax Number	:

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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Directions to “ MITZI HIDAKA ” Practice Location

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