Provider Demographics
NPI:1407403553
Name:HALL, ELLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AMMO INDUSTRIAL PARK
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-2215
Mailing Address - Country:US
Mailing Address - Phone:207-992-9200
Mailing Address - Fax:
Practice Address - Street 1:1 AMMO INDUSTRIAL PARK
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444
Practice Address - Country:US
Practice Address - Phone:207-992-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR68661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist