Provider Demographics
NPI:1922031483
Name:HILL PHARMACEUTICALS LLC
Entity Type:Organization
Organization Name:HILL PHARMACEUTICALS LLC
Other - Org Name:GLENN'S PRESCRIPTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHENA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-988-3226
Mailing Address - Street 1:119 E MAIN ST
Mailing Address - Street 2:PO BOX 316
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-9998
Mailing Address - Country:US
Mailing Address - Phone:270-988-3226
Mailing Address - Fax:270-988-4357
Practice Address - Street 1:119 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-9998
Practice Address - Country:US
Practice Address - Phone:270-988-3226
Practice Address - Fax:270-988-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP076563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710335670Medicaid
KY18D2159792OtherCLIA WAIVER
2148578OtherPK
KY7100169920Medicaid