Provider Demographics
NPI:1679756415
Name:HALL, EAGER (RPH)
Entity type:Individual
Prefix:MRS
First Name:EAGER
Middle Name:
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 1:1550 CANARSIE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5204
Mailing Address - Country:US
Mailing Address - Phone:718-251-0376
Mailing Address - Fax:718-251-0376
Practice Address - Street 1:4102 CHURCH AVE
Practice Address - Street 2:RITE AID OF NEW YORK, INC #3864
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3006
Practice Address - Country:US
Practice Address - Phone:718-940-1579
Practice Address - Fax:718-469-7283
Is Sole Proprietor?:No
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01589197Medicaid