Provider Demographics
NPI:1073629713
Name:HILLIARD PHARMACY INC
Entity Type:Organization
Organization Name:HILLIARD PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-845-3371
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:FL
Mailing Address - Zip Code:32046-0250
Mailing Address - Country:US
Mailing Address - Phone:904-845-3371
Mailing Address - Fax:
Practice Address - Street 1:551770 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:FL
Practice Address - Zip Code:32046-8820
Practice Address - Country:US
Practice Address - Phone:904-845-3371
Practice Address - Fax:904-845-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH4273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105227600Medicaid
1048859OtherOTHER ID NUMBER
0779340001Medicare NSC