Provider Demographics
NPI:1427061134
Name:HALL, JENNIFER MISCHELLE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MISCHELLE
Last Name:HALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WALLEN SUBDIVISION
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8590
Mailing Address - Country:US
Mailing Address - Phone:606-874-7060
Mailing Address - Fax:606-285-9281
Practice Address - Street 1:10870 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-285-9280
Practice Address - Fax:606-285-9281
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist