Provider Demographics
NPI:1073905113
Name:HALL, DENISE (DPH)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:ALLBRITTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPH
Mailing Address - Street 1:601 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-5025
Mailing Address - Country:US
Mailing Address - Phone:620-251-1620
Mailing Address - Fax:620-251-4730
Practice Address - Street 1:601 W 11TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-5025
Practice Address - Country:US
Practice Address - Phone:620-251-1620
Practice Address - Fax:620-251-4730
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist