Provider Demographics
NPI:1801019799
Name:HINS, DENNIS DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DEAN
Last Name:HINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-0200
Mailing Address - Country:US
Mailing Address - Phone:218-963-7525
Mailing Address - Fax:218-963-4722
Practice Address - Street 1:25527 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-0200
Practice Address - Country:US
Practice Address - Phone:218-963-7525
Practice Address - Fax:218-963-4722
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN12063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2407155OtherNCPDP
MN0958490001Medicare ID - Type Unspecified