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General NPI Number Information
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NPI Number | 1114098134
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Entity Type | Organization
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Legal Business Name | WHITE HALL PHARMACY LLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 1325 LOCUST AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-1435
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Country | US
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Telephone | 304-368-9355
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Fax | 304-367-8601
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Provider Business Mailing Address
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Address Line | 1325 LOCUST AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-1435
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Country | US
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Telephone | 304-368-9355
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Fax | 304-367-8601
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Authorized Official
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Title or Position | OWNER
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Name | TERRI VILAIN
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Credential | RPH
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Telephone | 304-368-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | SP0552374
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License Number State | WV
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