Provider Demographics
NPI:1821368150
Name:HALTER, PAUL CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:CHARLES
Last Name:HALTER
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 1:2123 34TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5243
Mailing Address - Country:US
Mailing Address - Phone:515-279-5001
Mailing Address - Fax:
Practice Address - Street 1:3140 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1328
Practice Address - Country:US
Practice Address - Phone:515-282-5295
Practice Address - Fax:515-282-7057
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist