Healthcare Provider Details

I. General information

NPI: 1760458475
Provider Name (Legal Business Name): ROBERT L HILLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

IV. Provider business mailing address

4430 S 73RD ST
TACOMA WA
98409-1415
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-2403
  • Fax: 253-403-1558
Mailing address:
  • Phone: 253-474-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00018819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: