Provider Demographics
NPI:1265740385
Name:HALL, AMY S (RPH)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:S
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 1:605 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3353
Mailing Address - Country:US
Mailing Address - Phone:662-323-8133
Mailing Address - Fax:662-324-9274
Practice Address - Street 1:605 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3353
Practice Address - Country:US
Practice Address - Phone:662-323-8133
Practice Address - Fax:662-324-9274
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD06935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist