Provider Demographics
NPI:1821012022
Name:HALL, KENNETH DALE (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DALE
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 1:295 FAIRFIELD LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-6511
Mailing Address - Country:US
Mailing Address - Phone:276-646-5630
Mailing Address - Fax:276-783-3839
Practice Address - Street 1:1581 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4317
Practice Address - Country:US
Practice Address - Phone:276-783-7284
Practice Address - Fax:276-783-3839
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist