MEDICARE: HALLS PHARMACY 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	3336C0003X	Community/Retail Pharmacy	2006022696	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2637037	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1255446290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLS PHARMACY INC

Provider Business Mailing Address
First Line	:	3021 HIGHWAY A
Second Line	:	STE 203
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5498
Country	:	US
Telephone Number	:	636-390-2828
Fax Number	:	636-390-2598

Provider Business Practice Location Address
First Line	:	3021 HIGHWAY A
Second Line	:	STE 203
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5498
Country	:	US
Telephone Number	:	636-390-2828
Fax Number	:	636-390-2598

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLARISSA HALL
Credential	:	PHARMD
Telephone Number	:	636-390-2828

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/09/2012

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Directions to “HALLS PHARMACY INC ” Practice Location

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