MEDICARE: MRS. MELISSA SUE HILLS RPH

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	5302030546	MI

General Provider Information

NPI Number	:	1902823446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA SUE HILLS RPH

Provider Business Mailing Address
First Line	:	3573 E 28TH STREET
Second Line	:
City	:	WHITE CLOUD
State	:	MI
Zip	:	49349
Country	:	US
Telephone Number	:	231-689-6392
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 S MAIN ST
Second Line	:	GRICES PHARMACY
City	:	KENT CITY
State	:	MI
Zip	:	49330
Country	:	US
Telephone Number	:	616-678-5380
Fax Number	:	616-678-9911

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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