=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063245751
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI HALL PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2024
-----------------------------------------------------
Last Update Date | 08/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 N COMMERCE PKWY
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33025-3959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-681-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3225 N HIATUS RD PO BOX 450094
-----------------------------------------------------
City | FT. LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-681-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS52732
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------