Provider Demographics
NPI:1760015382
Name:THILL, MICAH JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:JAMES
Last Name:THILL
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 1:464 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-9569
Mailing Address - Country:US
Mailing Address - Phone:920-661-9355
Mailing Address - Fax:920-661-9309
Practice Address - Street 1:464 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:WI
Practice Address - Zip Code:54313-9569
Practice Address - Country:US
Practice Address - Phone:920-661-9355
Practice Address - Fax:920-661-9309
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18472-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist