Healthcare Provider Details

I. General information

NPI: 1699377325
Provider Name (Legal Business Name): RENARD HILL PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 HIGHWAY 80 E
CLINTON MS
39056-5203
US

IV. Provider business mailing address

440 HUNTINGTON DR
JACKSON MS
39272-4486
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-8778
  • Fax: 601-924-2797
Mailing address:
  • Phone: 504-616-0620
  • Fax: 601-398-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.017413
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT-09957
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: