Provider Demographics
NPI:1760927081
Name:HALL, HALLE ALEXANDRIA (SLPA)
Entity Type:Individual
Prefix:
First Name:HALLE
Middle Name:ALEXANDRIA
Last Name:HALL
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 E WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3779
Mailing Address - Country:US
Mailing Address - Phone:951-213-7187
Mailing Address - Fax:
Practice Address - Street 1:773 E WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3779
Practice Address - Country:US
Practice Address - Phone:951-213-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120451183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician