Provider Demographics
NPI:1780782771
Name:HALE CENTER CLINICAL PHARMACY LLC
Entity type:Organization
Organization Name:HALE CENTER CLINICAL PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-839-2466
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:HALE CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:79041-0548
Mailing Address - Country:US
Mailing Address - Phone:806-839-2466
Mailing Address - Fax:806-839-3170
Practice Address - Street 1:601 AVENUE G
Practice Address - Street 2:
Practice Address - City:HALE CENTER
Practice Address - State:TX
Practice Address - Zip Code:79041-1450
Practice Address - Country:US
Practice Address - Phone:806-839-2466
Practice Address - Fax:806-839-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 332B00000X, 333600000X
TX291513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146231OtherPK
TX146920Medicaid
TX357616701Medicaid