Provider Demographics
NPI:1427686054
Name:HALLAHAN, JAMES (PHARMD/MBA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HALLAHAN
Suffix:
Gender:M
Credentials:PHARMD/MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 SONOMA PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2271
Mailing Address - Country:US
Mailing Address - Phone:248-703-7345
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST PAVILLION H
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI13119Medicaid