Provider Demographics
NPI:1871218610
Name:HILLIS, CHARLES PHILLIP (PHARMD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PHILLIP
Last Name:HILLIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 LAZY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1568
Mailing Address - Country:US
Mailing Address - Phone:903-240-1852
Mailing Address - Fax:
Practice Address - Street 1:1000 STONE RD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-5476
Practice Address - Country:US
Practice Address - Phone:903-984-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX042081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist