Provider Demographics
NPI:1629540729
Name:HILL, THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
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 1:559 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-3132
Mailing Address - Country:US
Mailing Address - Phone:386-931-2457
Mailing Address - Fax:
Practice Address - Street 1:1702 RIDGEWOOD AVE STE C
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-1783
Practice Address - Country:US
Practice Address - Phone:386-677-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist