Healthcare Provider Details

I. General information

NPI: 1770644353
Provider Name (Legal Business Name): HALLS DRUG CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S TOWER AVE SUITE 2
CENTRALIA WA
98531-3919
US

IV. Provider business mailing address

505 S TOWER AVE SUITE 2
CENTRALIA WA
98531-3919
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-0703
  • Fax: 360-736-8489
Mailing address:
  • Phone: 360-736-0703
  • Fax: 360-736-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number211003611
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number211003611
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number211003611
License Number StateWA

VIII. Authorized Official

Name: MR. WARREN A HALL
Title or Position: OWNER/PRESIDENT
Credential: RPH
Phone: 360-607-8757