Provider Demographics
NPI:1962003749
Name:HALL, ARTHUR M (DPH)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:M
Last Name:HALL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2879 FOXDEN RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-7767
Mailing Address - Country:US
Mailing Address - Phone:580-657-4674
Mailing Address - Fax:
Practice Address - Street 1:1715 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1535
Practice Address - Country:US
Practice Address - Phone:580-226-6444
Practice Address - Fax:580-226-6414
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist