Provider Demographics
NPI:1306213137
Name:HALL, SETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:SETH
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 1:6050 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-1703
Mailing Address - Country:US
Mailing Address - Phone:850-623-6604
Mailing Address - Fax:847-396-2779
Practice Address - Street 1:6050 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-1703
Practice Address - Country:US
Practice Address - Phone:850-623-6604
Practice Address - Fax:847-396-2779
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist