Provider Demographics
NPI:1073110763
Name:HILL, EZEKIEL JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EZEKIEL
Middle Name:JAMES
Last Name:HILL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6287 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-1925
Mailing Address - Country:US
Mailing Address - Phone:616-207-9463
Mailing Address - Fax:
Practice Address - Street 1:512 GOODRICH ST
Practice Address - Street 2:
Practice Address - City:VASSAR
Practice Address - State:MI
Practice Address - Zip Code:48768-9205
Practice Address - Country:US
Practice Address - Phone:989-823-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist