Provider Demographics
NPI:1104422898
Name:HILL, LIESA FRANCINE (PHARMD)
Entity type:Individual
Prefix:
First Name:LIESA
Middle Name:FRANCINE
Last Name:HILL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BROWNS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-1546
Mailing Address - Country:US
Mailing Address - Phone:423-821-8870
Mailing Address - Fax:
Practice Address - Street 1:321 BROWNS FERRY RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419-1546
Practice Address - Country:US
Practice Address - Phone:423-821-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO26764183500000X
TN10648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist