Provider Demographics
NPI:1205952355
Name:HALL, JAMES WAYNE (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WAYNE
Last Name:HALL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1807
Mailing Address - Country:US
Mailing Address - Phone:270-684-8240
Mailing Address - Fax:
Practice Address - Street 1:3030 BURLEW BLVD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6486
Practice Address - Country:US
Practice Address - Phone:270-684-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist