Provider Demographics
NPI:1992062350
Name:HALL, LAWRENCE RAY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RAY
Last Name:HALL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:RAY
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:751 S BASCOM AVE
Mailing Address - Street 2:INPATIENT PHARMACY
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:408-885-2382
Mailing Address - Fax:
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist