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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	CF00057531	WA

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	4916459	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1396838512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLS DRUG CENTER INC

Provider Business Mailing Address
First Line	:	505 S TOWER AVE STE 2
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-3919
Country	:	US
Telephone Number	:	360-736-3301
Fax Number	:	360-736-3494

Provider Business Practice Location Address
First Line	:	1805 COOKS HILL RD
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-9072
Country	:	US
Telephone Number	:	360-736-3301
Fax Number	:	360-736-3494

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	12/18/2009

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Directions to “HALLS DRUG CENTER INC ” Practice Location

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