Provider Demographics
NPI:1396838512
Name:HALLS DRUG CENTER INC
Entity Type:Organization
Organization Name:HALLS DRUG CENTER INC
Other - Org Name:HALLS MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-736-3301
Mailing Address - Street 1:505 S TOWER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3919
Mailing Address - Country:US
Mailing Address - Phone:360-736-3301
Mailing Address - Fax:360-736-3494
Practice Address - Street 1:1805 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9072
Practice Address - Country:US
Practice Address - Phone:360-736-3301
Practice Address - Fax:360-736-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
WACF000575313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6012504Medicaid
4916459OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4916459OtherNCPDP PROVIDER IDENTIFICATION NUMBER