Provider Demographics
NPI:1760895064
Name:HALL, RICHARD CHARLIE (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLIE
Last Name:HALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MICHIGAN ST NE STE 3100
Mailing Address - Street 2:ATTN. PHARMACY
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2563
Mailing Address - Country:US
Mailing Address - Phone:616-954-5555
Mailing Address - Fax:
Practice Address - Street 1:145 MICHIGAN ST NE STE 3100
Practice Address - Street 2:ATTN. PHARMACY
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2563
Practice Address - Country:US
Practice Address - Phone:616-954-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist