Provider Demographics
NPI:1568067858
Name:HALL, CORY MICHAEL
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:MICHAEL
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 RAGER LN
Mailing Address - Street 2:
Mailing Address - City:MC CLURE
Mailing Address - State:PA
Mailing Address - Zip Code:17841-9215
Mailing Address - Country:US
Mailing Address - Phone:570-492-3789
Mailing Address - Fax:
Practice Address - Street 1:33 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2124
Practice Address - Country:US
Practice Address - Phone:717-248-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist