Provider Demographics
NPI:1205271749
Name:HALL, STACIE LYNN (RPH)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2143
Mailing Address - Country:US
Mailing Address - Phone:812-265-7460
Mailing Address - Fax:812-265-7463
Practice Address - Street 1:711 GREEN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2143
Practice Address - Country:US
Practice Address - Phone:812-265-7460
Practice Address - Fax:812-265-7463
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019949A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist