Provider Demographics
NPI:1063417962
Name:HINMAN, CLINT E
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:E
Last Name:HINMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Mailing Address - Street 2:HOSPITAL DRIVE - OFF HIGHWAY 191 (PO BOX PH)
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-674-7502
Mailing Address - Fax:
Practice Address - Street 1:CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Practice Address - Street 2:HOSPITAL DRIVE - OFF HIGHWAY 191
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7502
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist