Provider Demographics
NPI:1265841464
Name:MIRE, HILLIARD JR
Entity Type:Individual
Prefix:
First Name:HILLIARD
Middle Name:
Last Name:MIRE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4858 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2627
Mailing Address - Country:US
Mailing Address - Phone:985-532-5527
Mailing Address - Fax:
Practice Address - Street 1:4858 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2627
Practice Address - Country:US
Practice Address - Phone:985-532-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist