Provider Demographics
NPI:1104355759
Name:HALL, GLORIA GRIGG
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:GRIGG
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 INGRAM DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-2984
Mailing Address - Country:US
Mailing Address - Phone:334-372-1171
Mailing Address - Fax:
Practice Address - Street 1:1420 HIGHWAY 231 S
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-2504
Practice Address - Country:US
Practice Address - Phone:334-566-8009
Practice Address - Fax:334-566-5739
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist