Healthcare Provider Details

I. General information

NPI: 1932017902
Provider Name (Legal Business Name): MISS HILLERY WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACARTHUR BLVD
SPRINGFIELD IL
62704
US

IV. Provider business mailing address

3100 MACARTHUR BLVD
SPRINGFIELD IL
62704
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-4936
  • Fax:
Mailing address:
  • Phone: 217-528-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049.295591
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: