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	PHAR.CF.60650596	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2106360	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588672661
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	:	360-736-5000
Fax Number	:	360-736-9433

Provider Business Practice Location Address
First Line	:	417 S TOWER AVE
Second Line	:	SUITE 2
City	:	CENTRALIA
State	:	WA
Zip	:	98531-3917
Country	:	US
Telephone Number	:	360-736-5000
Fax Number	:	360-736-9433

Authorized Official
Title or Position	:	OWNER
Name	:	WARREN HALL
Credential	:	RPH
Telephone Number	:	360-736-5000

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/18/2016

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Directions to “HALLS DRUG CENTER INC ” Practice Location

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