Healthcare Provider Details

I. General information

NPI: 1497437677
Provider Name (Legal Business Name): KATELIN HALL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 10/07/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 LAWNDALE DR
GREENSBORO NC
27455-3001
US

IV. Provider business mailing address

3703 LAWNDALE DR
GREENSBORO NC
27455-3001
US

V. Phone/Fax

Practice location:
  • Phone: 336-540-1344
  • Fax:
Mailing address:
  • Phone: 910-431-3641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32511
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: