Provider Demographics
NPI:1730464884
Name:HALL, CALLIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9355
Mailing Address - Country:US
Mailing Address - Phone:208-319-0600
Mailing Address - Fax:208-319-0606
Practice Address - Street 1:1625 S MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9355
Practice Address - Country:US
Practice Address - Phone:208-319-0600
Practice Address - Fax:208-319-0606
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2044183500000X
ORRPH-0016517183500000X
MN120783183500000X
IDP7898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist