Provider Demographics
NPI:1023187002
Name:HALL, MARY MARTHA (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARTHA
Last Name:HALL
Suffix:
Gender:F
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:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:WA
Mailing Address - Zip Code:99125-0024
Mailing Address - Country:US
Mailing Address - Phone:509-657-3457
Mailing Address - Fax:
Practice Address - Street 1:209 C STREET
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:WA
Practice Address - Zip Code:99125-0024
Practice Address - Country:US
Practice Address - Phone:509-657-3457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020888183500000X
AK1188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00020888OtherSTATE LICENSE