Provider Demographics
NPI:1417224361
Name:HILL, BRIAN L (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:HILL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:L
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3700 N LAKE SHORE DR
Mailing Address - Street 2:#308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4243
Mailing Address - Country:US
Mailing Address - Phone:773-868-1749
Mailing Address - Fax:773-868-0881
Practice Address - Street 1:11 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1601
Practice Address - Country:US
Practice Address - Phone:773-224-1211
Practice Address - Fax:773-224-1810
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370085651966Medicaid
IL370085651966Medicare UPIN
IL370085651966Medicaid
IL370085651966Medicare Oscar/Certification