Healthcare Provider Details

I. General information

NPI: 1427061134
Provider Name (Legal Business Name): JENNIFER MISCHELLE HALL PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10870 MAIN STREET
MARTIN KY
41649
US

IV. Provider business mailing address

59 WALLEN SUBDIVISION
PRESTONSBURG KY
41653-8590
US

V. Phone/Fax

Practice location:
  • Phone: 606-285-9280
  • Fax: 606-285-9281
Mailing address:
  • Phone: 606-874-7060
  • Fax: 606-285-9281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12676
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: