Provider Demographics
NPI:1093853913
Name:HALL, PHILIP M (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
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:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-0420
Mailing Address - Country:US
Mailing Address - Phone:931-879-9997
Mailing Address - Fax:931-879-9995
Practice Address - Street 1:433 W CENTRAL AVE
Practice Address - Street 2:HALL FAMILY PHARMACY
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3004
Practice Address - Country:US
Practice Address - Phone:931-879-9997
Practice Address - Fax:931-879-9995
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21874183500000X
332B00000X
TN00005328333600000X, 3336C0003X, 332BX2000X, 3336C0004X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4446476OtherNCPDP
TN00005328OtherPHARMACY
FH4383333OtherDEA
FH4383333OtherDEA