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General NPI Number Information
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NPI Number | 1114271749
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Entity Type | Individual
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Provider Name | ALEXIS BRENNA HATALA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 710 CENTER ST
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City | COLUMBUS
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State | GA
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Zip | 31901-1527
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Country | US
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Telephone | 706-571-1449
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 WILLIAMS CT APT. 1208
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City | COLUMBUS
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State | GA
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Zip | 31904-3901
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Country | US
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Telephone | 772-559-3687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH026910
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13509
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License Number State | SC
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