Provider Demographics
NPI:1780765750
Name:HALL, MATTIE J (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:MATTIE
Middle Name:J
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 1:58360 ISLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70765
Mailing Address - Country:US
Mailing Address - Phone:225-761-6700
Mailing Address - Fax:225-761-6760
Practice Address - Street 1:7968 ESSEN PARK
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-7439
Practice Address - Country:US
Practice Address - Phone:225-761-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist