Healthcare Provider Details

I. General information

NPI: 1750861605
Provider Name (Legal Business Name): JEFFREY HALL CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S EAGLE RD
EAGLE ID
83616-5907
US

IV. Provider business mailing address

265 S EAGLE RD
EAGLE ID
83616-5907
US

V. Phone/Fax

Practice location:
  • Phone: 208-319-0543
  • Fax: 208-319-0549
Mailing address:
  • Phone: 208-319-0543
  • Fax: 208-319-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: