Provider Demographics
NPI:1093317778
Name:HILL, BERNARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BYRAM DR APT 505
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-3507
Mailing Address - Country:US
Mailing Address - Phone:504-473-8772
Mailing Address - Fax:
Practice Address - Street 1:2711 GREENWAY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3304
Practice Address - Country:US
Practice Address - Phone:601-922-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021270183500000X
MSE13993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty