Provider Demographics
NPI:1710225297
Name:HALL, TERA (BSPHARM)
Entity Type:Individual
Prefix:MRS
First Name:TERA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E SILVER STAR RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7014
Mailing Address - Country:US
Mailing Address - Phone:407-522-2774
Mailing Address - Fax:407-522-4802
Practice Address - Street 1:1720 E SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-7014
Practice Address - Country:US
Practice Address - Phone:407-522-2774
Practice Address - Fax:407-522-4802
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist