Basic Information
| Provider Information | |||||||||
| NPI: | 1992305320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 432 HIGHWAY 277 N | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716558822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703671765 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1001 HIGHWAY 65 S | ||||||||
| Address2: | |||||||||
| City: | MC GEHEE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716549417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702226233 | ||||||||
| FaxNumber: | 8702226334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2020 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PD09691 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.