MEDICARE: BRIAN CHARLES HALL

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	112800	MN

General Provider Information

NPI Number	:	1689180606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN CHARLES HALL

Provider Business Mailing Address
First Line	:	2015 S BROADWAY ST
Second Line	:
City	:	NEW ULM
State	:	MN
Zip	:	56073-3954
Country	:	US
Telephone Number	:	507-354-9833
Fax Number	:	507-354-3908

Provider Business Practice Location Address
First Line	:	2015 S BROADWAY ST
Second Line	:
City	:	NEW ULM
State	:	MN
Zip	:	56073-3954
Country	:	US
Telephone Number	:	507-354-9833
Fax Number	:	507-354-3908

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

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	06/16/2018

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