Healthcare Provider Details

I. General information

NPI: 1922094572
Provider Name (Legal Business Name): STEVEN WAYNE HALL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N M ST
HUGO OK
74743-1820
US

IV. Provider business mailing address

PO BOX 973
DURANT OK
74702-0973
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-7561
  • Fax: 580-326-5941
Mailing address:
  • Phone: 580-745-9762
  • Fax: 580-326-5941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13614
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: