Healthcare Provider Details

I. General information

NPI: 1023004736
Provider Name (Legal Business Name): DENELLE LYNN HALL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6158 PALMA DEL MAR BLVD S 201B
ST PETERSBURG FL
33715-1295
US

IV. Provider business mailing address

6158 PALMA DEL MAR BLVD S
ST PETERSBURG FL
33715-1222
US

V. Phone/Fax

Practice location:
  • Phone: 941-721-0649
  • Fax:
Mailing address:
  • Phone: 941-721-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS 33455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: