Provider Demographics
NPI:1487939344
Name:HALL, RODERICK JAY SR (RPH)
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:JAY
Last Name:HALL
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2528
Mailing Address - Country:US
Mailing Address - Phone:856-293-9717
Mailing Address - Fax:856-293-7980
Practice Address - Street 1:1111 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2528
Practice Address - Country:US
Practice Address - Phone:856-293-9717
Practice Address - Fax:856-293-7980
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01500700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist