Healthcare Provider Details

I. General information

NPI: 1396832192
Provider Name (Legal Business Name): DAVID J HALLA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 HAMPTON BLVD
NORFOLK VA
23508-1800
US

IV. Provider business mailing address

120 FAYTON AVE
NORFOLK VA
23505-4428
US

V. Phone/Fax

Practice location:
  • Phone: 757-489-4848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202001721
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: