Provider Demographics
NPI:1629678503
Name:HILL, IAN D (PHARMD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:D
Last Name:HILL
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 1:555 COLEMANS XING
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7042
Mailing Address - Country:US
Mailing Address - Phone:937-644-3100
Mailing Address - Fax:937-644-2702
Practice Address - Street 1:555 COLEMANS XING
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7042
Practice Address - Country:US
Practice Address - Phone:937-644-3100
Practice Address - Fax:937-644-2702
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist