MEDICARE: KATHERINE HALLE

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	183500000X	Pharmacist	20073	NV
2	183500000X	Pharmacist	P7837	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20073	OTHER	NV	NEVADA BOARD OF PHARMACY
2	P7837	OTHER	ID	IDAHO BOARD OF PHARMACY

General Provider Information

NPI Number	:	1679098396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE HALLE

Provider Business Mailing Address
First Line	:	4747 S CHUGWATER WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83716-7161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6730 N HUALAPAI WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1358
Country	:	US
Telephone Number	:	702-670-4960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	04/01/2020

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Directions to “ KATHERINE HALLE ” Practice Location

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