Basic Information
| Provider Information | |||||||||
| NPI: | 1023115789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALES | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | R.PH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3019 COIT AVE NE | ||||||||
| Address2: | VA OUTPATIENT CLINIC | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495053376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163659575 | ||||||||
| FaxNumber: | 6163659487 | ||||||||
| Practice Location | |||||||||
| Address1: | 3019 COIT AVE NE | ||||||||
| Address2: | VA OUTPATIENT CLINIC | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495053376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163659575 | ||||||||
| FaxNumber: | 6163659487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5302022955 | MI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.