Provider Demographics
NPI:1770750754
Name:HALE, JOHN WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:HALE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12042 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-1022
Mailing Address - Country:US
Mailing Address - Phone:315-594-2222
Mailing Address - Fax:315-594-2227
Practice Address - Street 1:12042 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-1022
Practice Address - Country:US
Practice Address - Phone:315-594-2222
Practice Address - Fax:315-594-2227
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist