Healthcare Provider Details

I. General information

NPI: 1346355393
Provider Name (Legal Business Name): HALL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 WATER ST
SAUK CITY WI
53583-1502
US

IV. Provider business mailing address

803 WATER ST
SAUK CITY WI
53583-1502
US

V. Phone/Fax

Practice location:
  • Phone: 608-643-3717
  • Fax: 608-643-8920
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4150042
License Number StateWI

VIII. Authorized Official

Name: CHARLES HALL
Title or Position: OWNER
Credential:
Phone: 608-643-3717