Healthcare Provider Details

I. General information

NPI: 1174666002
Provider Name (Legal Business Name): HILLS DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238A HIGHWAY 62 412
HIGHLAND AR
72542-9468
US

IV. Provider business mailing address

1238A HIGHWAY 62 412
HIGHLAND AR
72542-9468
US

V. Phone/Fax

Practice location:
  • Phone: 870-994-2425
  • Fax: 870-994-2807
Mailing address:
  • Phone: 870-994-2425
  • Fax: 870-994-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberAR03155
License Number StateAR

VIII. Authorized Official

Name: MR. MAX LEE HILL
Title or Position: PHARMACIST
Credential: RPH
Phone: 870-994-2425