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NPI Code Detail

MEDICARE: DR. TED HALL PHARMD, BCPP, RPH

MEDICARE: DR. TED HALL PHARMD, BCPP, RPH
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
1183500000XPharmacistRP437956PA
21835P1200XPharmacotherapy Pharmacist13835040WI
3183500000XPharmacist13835040WI
41835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist13835-040WI
51835P1300XPsychiatric Pharmacist4090508WI

General Provider Information

NPI Number : 1598861346
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TED HALL PHARMD, BCPP, RPH
Provider Business Mailing Address
First Line : S2845 WHITE EAGLE ROAD
Second Line : HO-CHUNK HOUSE OF WELLNESS PHARMACY
City : BARABOO
State : WI
Zip : 53913-2880
Country : US
Telephone Number : 608-355-1240
Fax Number : 608-356-1233
Provider Business Practice Location Address
First Line : S2845 WHITE EAGLE RD
Second Line :
City : BARABOO
State : WI
Zip : 53913-9064
Country : US
Telephone Number : 608-355-0251
Fax Number : 608-355-9643
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 09/09/2013

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