Healthcare Provider Details

I. General information

NPI: 1104952167
Provider Name (Legal Business Name): LARRY KENNETH HILL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E 6TH ST
CORBIN KY
40701-1422
US

IV. Provider business mailing address

PO BOX 757 160 LINDENBERG DRIVE
WILLIAMSBURG KY
40769-0757
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-4380
  • Fax: 606-526-7258
Mailing address:
  • Phone: 606-549-0936
  • Fax: 606-526-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number006843
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: