Provider Demographics
NPI:1639290869
Name:HALSELL, LILLIE (PD)
Entity Type:Individual
Prefix:MS
First Name:LILLIE
Middle Name:
Last Name:HALSELL
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-6313
Mailing Address - Country:US
Mailing Address - Phone:504-388-5239
Mailing Address - Fax:
Practice Address - Street 1:4600 CHEF MENTEUR HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-5011
Practice Address - Country:US
Practice Address - Phone:504-947-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA16878OtherPHARMACY