Healthcare Provider Details

I. General information

NPI: 1891089264
Provider Name (Legal Business Name): LYNETTE HALL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 NW FEDERAL HWY T-0816
STUART FL
34994-9318
US

IV. Provider business mailing address

2650 NW FEDERAL HWY T-0816
STUART FL
34994-9318
US

V. Phone/Fax

Practice location:
  • Phone: 772-692-8090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: