=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093315830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN HALE APA JR. PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2020
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 W COURT ST
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75966-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-379-5160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 733 COUNTY ROAD 427
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75951-1264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 39136
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051.298992
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 72331
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------