Provider Demographics
NPI:1427226489
Name:HILLER, MICHAEL D (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:HILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9385
Mailing Address - Country:US
Mailing Address - Phone:608-839-3784
Mailing Address - Fax:608-839-3786
Practice Address - Street 1:431 W COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-9385
Practice Address - Country:US
Practice Address - Phone:608-839-3784
Practice Address - Fax:608-839-3786
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR10177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist