=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083302061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE HALL PHARM.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2023
-----------------------------------------------------
Last Update Date | 04/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10109 E. 79TH ST. OUTPATIENT PHARMACY
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-771-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4916 S NARCISSUS AVE
-----------------------------------------------------
City | BROKEN ARROW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74011-4217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-946-4587
-----------------------------------------------------
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 | R-16171
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------