Provider Demographics
NPI:1639782576
Name:HALL, NYASHA MACK (PHARMD)
Entity Type:Individual
Prefix:
First Name:NYASHA
Middle Name:MACK
Last Name:HALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LAKE MONTEREY CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8436
Mailing Address - Country:US
Mailing Address - Phone:305-484-6103
Mailing Address - Fax:561-585-2610
Practice Address - Street 1:7031 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-5201
Practice Address - Country:US
Practice Address - Phone:561-585-6911
Practice Address - Fax:561-585-2610
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS338241835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS33824OtherFLORIDA BOARD OF PHARMACY