Provider Demographics
NPI:1386762813
Name:HALL, DEWARD LEON (BS PHARMACY)
Entity type:Individual
Prefix:
First Name:DEWARD
Middle Name:LEON
Last Name:HALL
Suffix:
Gender:M
Credentials:BS PHARMACY
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 667
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:UT
Mailing Address - Zip Code:84725-0667
Mailing Address - Country:US
Mailing Address - Phone:435-878-5058
Mailing Address - Fax:
Practice Address - Street 1:2610 PIONEER RD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7442
Practice Address - Country:US
Practice Address - Phone:435-674-5792
Practice Address - Fax:435-674-9354
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142290-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist