Provider Demographics
NPI:1629182613
Name:HILLIARD DRUGS INC
Entity Type:Organization
Organization Name:HILLIARD DRUGS INC
Other - Org Name:HILLIARD DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-396-2214
Mailing Address - Street 1:1001 NW 2ND ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144-2424
Mailing Address - Country:US
Mailing Address - Phone:903-396-2214
Mailing Address - Fax:903-396-7588
Practice Address - Street 1:1001 NW 2ND ST STE 300
Practice Address - Street 2:
Practice Address - City:KERENS
Practice Address - State:TX
Practice Address - Zip Code:75144-2424
Practice Address - Country:US
Practice Address - Phone:903-396-2214
Practice Address - Fax:903-396-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX13613336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149353Medicaid
2097978OtherPK