Provider Demographics
NPI:1992307680
Name:HALL, TONI A
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:A
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 1:550 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5508
Mailing Address - Country:US
Mailing Address - Phone:304-622-2784
Mailing Address - Fax:304-622-2784
Practice Address - Street 1:550 EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5508
Practice Address - Country:US
Practice Address - Phone:304-622-2784
Practice Address - Fax:304-622-2784
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00005854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist