Provider Demographics
NPI:1588672661
Name:HALLS DRUG CENTER INC
Entity Type:Organization
Organization Name:HALLS DRUG CENTER INC
Other - Org Name:SOUTH TOWER 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:RPH
Authorized Official - Phone:360-736-5000
Mailing Address - Street 1:1205 CENTRALIA AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3705
Mailing Address - Country:US
Mailing Address - Phone:360-736-5000
Mailing Address - Fax:360-736-9433
Practice Address - Street 1:417 S TOWER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3917
Practice Address - Country:US
Practice Address - Phone:360-736-5000
Practice Address - Fax:360-736-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
WAPHAR.CF.606505963336C0003X
WAPHAR.CF.000575323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2106360OtherPK
WA6109706Medicaid
WA6109706Medicaid