Provider Demographics
NPI:1114459245
Name:HILLESHEIM, GRACE (PHARMD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HILLESHEIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 4TH AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1879
Mailing Address - Country:US
Mailing Address - Phone:320-634-4434
Mailing Address - Fax:
Practice Address - Street 1:7 4TH AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1879
Practice Address - Country:US
Practice Address - Phone:320-634-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist