1770644353 NPI number — HALLS DRUG CENTER INC

Table of content: (NPI 1770644353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770644353 NPI number — HALLS DRUG CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALLS DRUG CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770644353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 S TOWER AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98531-3919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-736-0703
Provider Business Mailing Address Fax Number:
360-736-8489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 S TOWER AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98531-3919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-736-0703
Provider Business Practice Location Address Fax Number:
360-736-8489
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
WARREN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
360-607-8757

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  211003611 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 211003611 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 211003611 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9034851 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9049669 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018653 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6012504 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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