Provider Demographics
NPI:1528050697
Name:HALE, LONNIE PRESTON (RPH)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:PRESTON
Last Name:HALE
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 1:13509 REYNARD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7653
Mailing Address - Country:US
Mailing Address - Phone:804-360-2928
Mailing Address - Fax:
Practice Address - Street 1:4202 PARK PLACE CT
Practice Address - Street 2:SUITE E
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3329
Practice Address - Country:US
Practice Address - Phone:804-762-9135
Practice Address - Fax:804-762-9100
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist