Provider Demographics
NPI:1104643543
Name:HILO, ALEXANDER KOMA
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:KOMA
Last Name:HILO
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 1:320 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1035
Mailing Address - Country:US
Mailing Address - Phone:360-855-0735
Mailing Address - Fax:360-855-0912
Practice Address - Street 1:320 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1035
Practice Address - Country:US
Practice Address - Phone:360-855-0735
Practice Address - Fax:360-855-0912
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61302659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist