Provider Demographics
NPI:1972859270
Name:HILLER, RICHARD D (PD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:HILLER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SERENITY WAY
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2232
Mailing Address - Country:US
Mailing Address - Phone:410-581-5832
Mailing Address - Fax:
Practice Address - Street 1:14391 CHANTILLY CROSSING LN
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2118
Practice Address - Country:US
Practice Address - Phone:571-262-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211212183500000X
MD10814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist