Provider Demographics
NPI:1528648698
Name:HALL, ASHLEY BROOK
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BROOK
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WALMART
Mailing Address - Street 2:11214 JEFFERSON AVE
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601
Mailing Address - Country:US
Mailing Address - Phone:757-327-7478
Mailing Address - Fax:757-327-7474
Practice Address - Street 1:WALMART PHARMACY
Practice Address - Street 2:11214 JEFFERSON AVE
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601
Practice Address - Country:US
Practice Address - Phone:757-327-7478
Practice Address - Fax:757-327-7474
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230002278183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0230002278OtherTECHNICIAN LICENSE