1154840924 NPI number — MRS. TASHENA ELIZABETH HILL PHARM D

Table of content: MRS. TASHENA ELIZABETH HILL PHARM D (NPI 1154840924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154840924 NPI number — MRS. TASHENA ELIZABETH HILL PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
TASHENA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154840924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 366
Provider Second Line Business Mailing Address:
520 WEST GUM ST.
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-965-4101
Provider Business Mailing Address Fax Number:
270-965-9957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 WEST GUM ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-965-4101
Provider Business Practice Location Address Fax Number:
270-965-9957
Provider Enumeration Date:
09/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  015592 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18D2159791 . This is a "CLIA WAIVER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 18D2159792 . This is a "CLIA WAIVER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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