Healthcare Provider Details

I. General information

NPI: 1184670085
Provider Name (Legal Business Name): HILL'S PHARMACY OF VICKSBURG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S MAIN ST
VICKSBURG MI
49097-1211
US

IV. Provider business mailing address

110 S MAIN ST
VICKSBURG MI
49097-1211
US

V. Phone/Fax

Practice location:
  • Phone: 269-649-1476
  • Fax: 269-649-4007
Mailing address:
  • Phone: 269-649-1476
  • Fax: 269-649-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301005736
License Number StateMI

VIII. Authorized Official

Name: KELLY SOEKARMOEN
Title or Position: OWNER/PHARMACIST
Credential: R.PH.
Phone: 269-649-1476