Provider Demographics
NPI:1770644353
Name:HALLS DRUG CENTER INC
Entity Type:Organization
Organization Name:HALLS DRUG CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-607-8757
Mailing Address - Street 1:505 S TOWER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3919
Mailing Address - Country:US
Mailing Address - Phone:360-736-0703
Mailing Address - Fax:360-736-8489
Practice Address - Street 1:505 S TOWER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3919
Practice Address - Country:US
Practice Address - Phone:360-736-0703
Practice Address - Fax:360-736-8489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALLS DRUG CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA211003611332BC3200X, 333600000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9034851Medicaid
WA9049669Medicaid
WA1018653Medicaid
WA6012504Medicaid
WA9034851Medicaid