Provider Demographics
NPI:1790061802
Name:HALLE, MICHAEL ROBERT (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:HALLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 COOK RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:ME
Mailing Address - Zip Code:04419-3715
Mailing Address - Country:US
Mailing Address - Phone:401-263-3942
Mailing Address - Fax:
Practice Address - Street 1:353 MAIN ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6211
Practice Address - Country:US
Practice Address - Phone:207-945-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist