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Get HI 204 Instructions 2007-2024

Enter the recipient’s identification number. 2. Recipient’s Name: Enter the recipient’s name: first and last name. 3. Date of Birth: Enter the recipient’s date of birth: mm/dd/yyyy. 4. Pharmacy’s National Provider Identifier (NPI): Enter the pharmacy’s NPI. 5. Pharmacy’s Name: Enter the name of the pharmacy. 6. Pharmacy’s Address: Enter the address of the pharmacy, including city and zip code. 7. Prescriber’s NPI: Enter the prescriber’s NPI. 8. Prescriber’s Drug Enforcemen.

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