Provider Demographics
NPI:1558734186
Name:HALL FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:HALL FAMILY PHARMACY INC
Other - Org Name:HALL FAMILY PHARMACY AT CLARKRANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-863-3323
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-0420
Mailing Address - Country:US
Mailing Address - Phone:931-863-3323
Mailing Address - Fax:931-863-3343
Practice Address - Street 1:6845 S YORK HWY
Practice Address - Street 2:
Practice Address - City:CLARKRANGE
Practice Address - State:TN
Practice Address - Zip Code:38553-5154
Practice Address - Country:US
Practice Address - Phone:931-863-3323
Practice Address - Fax:931-863-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TN57303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033159Medicaid
4448482OtherNCPDP
2157821OtherPK
2157821OtherPK