Provider Demographics
NPI:1598861346
Name:HALL, TED (PHARMD, BCPP, RPH)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:PHARMD, BCPP, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S2845 WHITE EAGLE ROAD
Mailing Address - Street 2:HO-CHUNK HOUSE OF WELLNESS PHARMACY
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2880
Mailing Address - Country:US
Mailing Address - Phone:608-355-1240
Mailing Address - Fax:608-356-1233
Practice Address - Street 1:S2845 WHITE EAGLE RD
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9064
Practice Address - Country:US
Practice Address - Phone:608-355-0251
Practice Address - Fax:608-355-9643
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437956183500000X
WI138350401835P1200X, 183500000X
WI13835-0401835P0018X
WI40905081835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric