Provider Demographics
NPI:1770351330
Name:HALL, MADELYN ELIZABETH
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 CREEKSIDE BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-3318
Mailing Address - Country:US
Mailing Address - Phone:210-606-1104
Mailing Address - Fax:
Practice Address - Street 1:5808 BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1100
Practice Address - Country:US
Practice Address - Phone:512-454-6691
Practice Address - Fax:512-451-7876
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291404183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician