Provider Demographics
NPI:1720816556
Name:HALLE, SHAUNA KAY
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:KAY
Last Name:HALLE
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 1:1920 E MARKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6236
Mailing Address - Country:US
Mailing Address - Phone:765-456-3641
Mailing Address - Fax:
Practice Address - Street 1:1920 E MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6236
Practice Address - Country:US
Practice Address - Phone:765-456-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67041893A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist