Provider Demographics
NPI:1477633691
Name:HALL, INGRID A (DPH)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 EDGEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-4230
Mailing Address - Country:US
Mailing Address - Phone:423-775-2672
Mailing Address - Fax:423-775-2672
Practice Address - Street 1:420 MARKET ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1638
Practice Address - Country:US
Practice Address - Phone:423-570-0325
Practice Address - Fax:423-570-0325
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist