Provider Demographics
NPI:1790970903
Name:HALLETTSVILLE PHARMACY LLC
Entity Type:Organization
Organization Name:HALLETTSVILLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:HORTON
Authorized Official - Last Name:GRAHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:361-798-5010
Mailing Address - Street 1:304 N TEXANA ST
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-2322
Mailing Address - Country:US
Mailing Address - Phone:361-798-5010
Mailing Address - Fax:361-798-1616
Practice Address - Street 1:304 N TEXANA ST
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-2322
Practice Address - Country:US
Practice Address - Phone:361-798-5010
Practice Address - Fax:361-798-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25318332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5826360001Medicare NSC