Provider Demographics
NPI:1023391349
Name:HALL, TERESA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N BUCKMAN ST
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-5900
Mailing Address - Country:US
Mailing Address - Phone:502-543-2202
Mailing Address - Fax:502-543-1040
Practice Address - Street 1:152 N BUCKMAN ST
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-5900
Practice Address - Country:US
Practice Address - Phone:502-543-2202
Practice Address - Fax:502-543-1040
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist