Provider Demographics
NPI:1801497326
Name:HILLEGASS, HEIDI DAWN
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:DAWN
Last Name:HILLEGASS
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 1:72 BEDFORD SQ
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-6934
Mailing Address - Country:US
Mailing Address - Phone:814-623-1995
Mailing Address - Fax:814-623-2545
Practice Address - Street 1:72 BEDFORD SQ
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-6934
Practice Address - Country:US
Practice Address - Phone:814-623-1995
Practice Address - Fax:814-623-2545
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043147L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist