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General NPI Number Information
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NPI Number | 1891334447
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Entity Type | Individual
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Provider Name | JACOB W HALL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/30/2019
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 3040 DOLPHIN DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7135
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Country | US
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Telephone | 270-737-4578
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Fax |
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Provider Business Mailing Address
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Address Line | 416 S 6TH ST
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City | BARDSTOWN
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State | KY
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Zip | 40004-1132
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Country | US
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Telephone | 502-827-9994
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 019523
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License Number State | KY
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