MEDICARE: MR. LONNIE PRESTON HALE R.PH.

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	183500000X	Pharmacist	4571	VA

General Provider Information

NPI Number	:	1528050697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LONNIE PRESTON HALE R.PH.

Provider Business Mailing Address
First Line	:	13509 REYNARD LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-7653
Country	:	US
Telephone Number	:	804-360-2928
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 PARK PLACE CT
Second Line	:	SUITE E
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-3329
Country	:	US
Telephone Number	:	804-762-9135
Fax Number	:	804-762-9100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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