Provider Demographics
NPI:1275719643
Name:MARTIN E. HALE DISPENSARY
Entity Type:Organization
Organization Name:MARTIN E. HALE DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-474-3223
Mailing Address - Street 1:PO BOX 4688
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33338-4688
Mailing Address - Country:US
Mailing Address - Phone:954-376-7313
Mailing Address - Fax:954-524-9711
Practice Address - Street 1:499 NW 70TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-7500
Practice Address - Country:US
Practice Address - Phone:954-474-3223
Practice Address - Fax:954-474-3226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN'S CHOICE DISPENSING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-16
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46937332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site