Provider Demographics
NPI:1902925340
Name:HALL, JOHN T (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:HALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:174A YOUNG AVE
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858
Mailing Address - Country:US
Mailing Address - Phone:662-963-2367
Mailing Address - Fax:662-963-2392
Practice Address - Street 1:174A YOUNG AVE
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858
Practice Address - Country:US
Practice Address - Phone:662-963-2367
Practice Address - Fax:662-963-2392
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00489 011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00035556Medicaid