Provider Demographics
NPI:1992700017
Name:HINES, NORMAN L (RPH)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:L
Last Name:HINES
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 1:7845 S COTTAGE GROVE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3100
Mailing Address - Country:US
Mailing Address - Phone:773-873-4400
Mailing Address - Fax:773-873-5635
Practice Address - Street 1:7845 S COTTAGE GROVE AVE
Practice Address - Street 2:STE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3100
Practice Address - Country:US
Practice Address - Phone:773-873-4400
Practice Address - Fax:773-873-5635
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist