MEDICARE: HALLS DRUG CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	CF60099201	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2108022	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205929429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLS DRUG CENTER INC

Provider Business Mailing Address
First Line	:	1205 CENTRALIA AVE
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-3705
Country	:	US
Telephone Number	:	360-736-3301
Fax Number	:	360-736-6934

Provider Business Practice Location Address
First Line	:	505 S TOWER AVE STE 2B
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-3919
Country	:	US
Telephone Number	:	360-736-5000
Fax Number	:	360-736-6934

Authorized Official
Title or Position	:	OWNER
Name	:	WARREN HALL
Credential	:
Telephone Number	:	360-736-3301

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/09/2016

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Directions to “HALLS DRUG CENTER INC ” Practice Location

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