Provider Demographics
NPI:1841805249
Name:HALL, CARL L III
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:L
Last Name:HALL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 E. US HWY 69
Mailing Address - Street 2:
Mailing Address - City:EMORY
Mailing Address - State:TX
Mailing Address - Zip Code:75440
Mailing Address - Country:US
Mailing Address - Phone:903-473-4523
Mailing Address - Fax:903-473-4525
Practice Address - Street 1:959 E. US HWY 69
Practice Address - Street 2:
Practice Address - City:EMORY
Practice Address - State:TX
Practice Address - Zip Code:75440
Practice Address - Country:US
Practice Address - Phone:903-473-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21559OtherSTATE OF TEXAS