MEDICARE: HALLS DRUG CENTER INC

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	333600000X	Pharmacy	211003611	WA
2	335E00000X	Prosthetic/Orthotic Supplier	211003611	WA
3	332BC3200X	Customized Equipment (DME)	211003611	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770644353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLS DRUG CENTER INC

Provider Business Mailing Address
First Line	:	505 S TOWER AVE
Second Line	:	SUITE 2
City	:	CENTRALIA
State	:	WA
Zip	:	98531-3919
Country	:	US
Telephone Number	:	360-736-0703
Fax Number	:	360-736-8489

Provider Business Practice Location Address
First Line	:	505 S TOWER AVE
Second Line	:	SUITE 2
City	:	CENTRALIA
State	:	WA
Zip	:	98531-3919
Country	:	US
Telephone Number	:	360-736-0703
Fax Number	:	360-736-8489

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. WARREN A HALL
Credential	:	RPH
Telephone Number	:	360-607-8757

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	06/23/2011

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Directions to “HALLS DRUG CENTER INC ” Practice Location

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