MEDICARE: HALLSVILLE DRUG & HARDWARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	26513	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2123028	OTHER		PK

General Provider Information

NPI Number	:	1215099148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLSVILLE DRUG & HARDWARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 96
Second Line	:	100 E. MAIN
City	:	HALLSVILLE
State	:	TX
Zip	:	75650-0096
Country	:	US
Telephone Number	:	903-660-2012
Fax Number	:	903-668-2015

Provider Business Practice Location Address
First Line	:	100 EAST MAIN
Second Line	:
City	:	HALLSVILLE
State	:	TX
Zip	:	75650
Country	:	US
Telephone Number	:	903-668-2012
Fax Number	:	903-668-2015

Authorized Official
Title or Position	:	RPH
Name	:	MIKE BUCHANAN
Credential	:
Telephone Number	:	903-660-2012

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	06/03/2014

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Directions to “HALLSVILLE DRUG & HARDWARE LLC ” Practice Location

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