Provider Demographics
NPI:1215099148
Name:HALLSVILLE DRUG & HARDWARE LLC
Entity type:Organization
Organization Name:HALLSVILLE DRUG & HARDWARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-660-2012
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:100 E. MAIN
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-0096
Mailing Address - Country:US
Mailing Address - Phone:903-660-2012
Mailing Address - Fax:903-668-2015
Practice Address - Street 1:100 EAST MAIN
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650
Practice Address - Country:US
Practice Address - Phone:903-668-2012
Practice Address - Fax:903-668-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123028OtherPK