Provider Demographics
NPI:1891977013
Name:HALL, KERRY DWIGHT (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:DWIGHT
Last Name:HALL
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 1:1550 CANARSIE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5204
Mailing Address - Country:US
Mailing Address - Phone:718-791-6675
Mailing Address - Fax:
Practice Address - Street 1:1450 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2602
Practice Address - Country:US
Practice Address - Phone:718-272-2504
Practice Address - Fax:718-272-2579
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist