=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023029527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALLS DRUG CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 07/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 417 S TOWER AVE
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-736-4433
-----------------------------------------------------
Fax | 360-736-8709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 417 S TOWER AVE
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-736-4433
-----------------------------------------------------
Fax | 360-736-8709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES CEO
-----------------------------------------------------
Name | MR. WARREN LLOYD HALL
-----------------------------------------------------
Credential | PHARMACIST RPH
-----------------------------------------------------
Telephone | 360-736-3301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | CF00003081
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | CF00058999
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------