Provider Demographics
NPI:1831412097
Name:HALL, AMY COLLEEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:COLLEEN
Last Name:HALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:COLLEEN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3242 ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:YORKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:14173
Mailing Address - Country:US
Mailing Address - Phone:716-492-0176
Mailing Address - Fax:
Practice Address - Street 1:3242 ROUTE 39
Practice Address - Street 2:
Practice Address - City:YORKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:14173
Practice Address - Country:US
Practice Address - Phone:716-492-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI053572-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist