MEDICARE: MR. KERRY DWIGHT HALL PHARMD.

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	050480	NY

General Provider Information

NPI Number	:	1891977013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KERRY DWIGHT HALL PHARMD.

Provider Business Mailing Address
First Line	:	1550 CANARSIE RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5204
Country	:	US
Telephone Number	:	718-791-6675
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-2602
Country	:	US
Telephone Number	:	718-272-2504
Fax Number	:	718-272-2579

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

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	11/29/2007

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