Provider Demographics
NPI:1336733757
Name:HALL, ERICA PAIGE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:PAIGE
Last Name:HALL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11155 US HWY 23 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BETSY LAYNE
Mailing Address - State:KY
Mailing Address - Zip Code:41605
Mailing Address - Country:US
Mailing Address - Phone:606-478-9474
Mailing Address - Fax:
Practice Address - Street 1:11155 US HWY 23 SOUTH
Practice Address - Street 2:
Practice Address - City:BETSY LAYNE
Practice Address - State:KY
Practice Address - Zip Code:41605-4160
Practice Address - Country:US
Practice Address - Phone:606-478-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist