MEDICARE: DR. CLARISSA E HALL PHARM.D.

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	2006026097	MO

General Provider Information

NPI Number	:	1831241736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARISSA E HALL PHARM.D.

Provider Business Mailing Address
First Line	:	3021 HIGHWAY A
Second Line	:	SUITE 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	:	SUITE 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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