Provider Demographics
NPI:1669894069
Name:HALL, ROSE CAROL (RPH)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:CAROL
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 1:22991 JOHN T REID PKWY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-3075
Mailing Address - Country:US
Mailing Address - Phone:256-259-2530
Mailing Address - Fax:256-259-5603
Practice Address - Street 1:22991 JOHN T REID PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-3075
Practice Address - Country:US
Practice Address - Phone:256-259-2530
Practice Address - Fax:256-259-5603
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist