Healthcare Provider Details

I. General information

NPI: 1588672661
Provider Name (Legal Business Name): HALLS DRUG CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S TOWER AVE SUITE 2
CENTRALIA WA
98531-3917
US

IV. Provider business mailing address

1205 CENTRALIA AVE
CENTRALIA WA
98531-3705
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-5000
  • Fax: 360-736-9433
Mailing address:
  • Phone: 360-736-5000
  • Fax: 360-736-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60650596
License Number StateWA

VIII. Authorized Official

Name: WARREN HALL
Title or Position: OWNER
Credential: RPH
Phone: 360-736-5000