Provider Demographics
NPI:1023029527
Name:HALLS DRUG CENTER INC.
Entity Type:Organization
Organization Name:HALLS DRUG CENTER INC.
Other - Org Name:SOUTH TOWER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST RPH
Authorized Official - Phone:360-736-3301
Mailing Address - Street 1:417 S TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-736-4433
Mailing Address - Fax:360-736-8709
Practice Address - Street 1:417 S TOWER AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:360-736-4433
Practice Address - Fax:360-736-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00003081333600000X
3336C0003X
WACF000589993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4918174OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WA6003941Medicaid
WA6031025Medicaid
4918174OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WA0956320001Medicare NSC