Provider Demographics
NPI:1881730174
Name:HILL, DERYCK K (RPH)
Entity type:Individual
Prefix:
First Name:DERYCK
Middle Name:K
Last Name:HILL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BURCH PL.
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:575-218-3905
Mailing Address - Fax:
Practice Address - Street 1:208 W. CASABLANCA AVE BLDG 1400
Practice Address - Street 2:27 SOMDG
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5014
Practice Address - Country:US
Practice Address - Phone:575-784-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist