Healthcare Provider Details

I. General information

NPI: 1386628568
Provider Name (Legal Business Name): MRS. LAUREN A HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 15TH AVE SW
SEATTLE WA
98106-2820
US

IV. Provider business mailing address

2178 GARFIELD AVE SE
PORT ORCHARD WA
98366-8770
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-2728
  • Fax: 206-762-7630
Mailing address:
  • Phone: 360-871-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00045807
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: