Provider Demographics
NPI:1538248109
Name:HALL, MINA CAROL (RPH)
Entity type:Individual
Prefix:MS
First Name:MINA
Middle Name:CAROL
Last Name:HALL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 N WATKINS ST STE 101-102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-6405
Mailing Address - Country:US
Mailing Address - Phone:901-930-0999
Mailing Address - Fax:901-324-1051
Practice Address - Street 1:3360 N WATKINS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6405
Practice Address - Country:US
Practice Address - Phone:901-930-0999
Practice Address - Fax:901-324-1051
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist