Provider Demographics
NPI:1366514143
Name:NIC-HIL INC
Entity type:Organization
Organization Name:NIC-HIL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:479-571-4545
Mailing Address - Street 1:2818 W MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7625
Mailing Address - Country:US
Mailing Address - Phone:479-571-4545
Mailing Address - Fax:479-571-4050
Practice Address - Street 1:2818 W MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7625
Practice Address - Country:US
Practice Address - Phone:479-571-4545
Practice Address - Fax:479-571-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0420120333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134268407Medicaid
0420199OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AR13507716Medicaid
AR13507716Medicaid
0420199OtherOTHER ID NUMBER-COMMERCIAL NUMBER