Provider Demographics
NPI:1063015501
Name:HALL, KRISTOPHER I
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:HALL
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 GATEWAY CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-9204
Mailing Address - Country:US
Mailing Address - Phone:270-351-3625
Mailing Address - Fax:
Practice Address - Street 1:102 GATEWAY CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-9204
Practice Address - Country:US
Practice Address - Phone:270-351-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist