Provider Demographics
NPI:1093145518
Name:HALL, STEPHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77805 VINEYARD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN MIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:93451-9757
Mailing Address - Country:US
Mailing Address - Phone:805-467-3344
Mailing Address - Fax:
Practice Address - Street 1:2995 MCMILLAN AVE
Practice Address - Street 2:SUITE 196
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6769
Practice Address - Country:US
Practice Address - Phone:805-546-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist