Provider Demographics
NPI:1467969402
Name:HASSAN, HILDA DOLAPO
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:DOLAPO
Last Name:HASSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2937 SHETLAND LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4104
Mailing Address - Country:US
Mailing Address - Phone:847-807-9288
Mailing Address - Fax:
Practice Address - Street 1:2937 SHETLAND LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-4104
Practice Address - Country:US
Practice Address - Phone:847-807-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-2994401835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric