Provider Demographics
NPI:1043592819
Name:HALL, LOU BLALOCK (RPH)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:BLALOCK
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 1:5373 PEACHTREE IND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2139
Mailing Address - Country:US
Mailing Address - Phone:678-547-1672
Mailing Address - Fax:678-547-1780
Practice Address - Street 1:5373 PEACHTREE IND BLVD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2139
Practice Address - Country:US
Practice Address - Phone:678-547-1672
Practice Address - Fax:678-547-1780
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist