Provider Demographics
NPI:1760082275
Name:DODSON, HILLARY
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:DODSON
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 1:47216 253RD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:SD
Mailing Address - Zip Code:57003-5923
Mailing Address - Country:US
Mailing Address - Phone:605-448-6877
Mailing Address - Fax:
Practice Address - Street 1:3209 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-0704
Practice Address - Country:US
Practice Address - Phone:605-362-1602
Practice Address - Fax:605-362-1802
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist