Provider Demographics
NPI:1992305320
Name:HILL, BRADFORD LEE
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:LEE
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 HIGHWAY 277 N
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-8822
Mailing Address - Country:US
Mailing Address - Phone:870-367-1765
Mailing Address - Fax:
Practice Address - Street 1:1001 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-9417
Practice Address - Country:US
Practice Address - Phone:870-222-6233
Practice Address - Fax:870-222-6334
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist