Provider Demographics
NPI:1528395837
Name:HILLGOTH, DAVID P (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:HILLGOTH
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 1:5324 N OKETO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1761
Mailing Address - Country:US
Mailing Address - Phone:773-430-6079
Mailing Address - Fax:
Practice Address - Street 1:5324 N OKETO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1761
Practice Address - Country:US
Practice Address - Phone:773-430-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist