Basic Information
| Provider Information | |||||||||
| NPI: | 1598861346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | TED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD, BCPP, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | S2845 WHITE EAGLE ROAD | ||||||||
| Address2: | HO-CHUNK HOUSE OF WELLNESS PHARMACY | ||||||||
| City: | BARABOO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539132880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083551240 | ||||||||
| FaxNumber: | 6083561233 | ||||||||
| Practice Location | |||||||||
| Address1: | S2845 WHITE EAGLE RD | ||||||||
| Address2: | |||||||||
| City: | BARABOO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539139064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083550251 | ||||||||
| FaxNumber: | 6083559643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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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 | RP437956 | PA | N | Pharmacy Service Providers | Pharmacist | 1835P1200X | 13835040 | WI | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 183500000X | 13835040 | WI | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | 13835-040 | WI | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P1300X | 4090508 | WI | N | Pharmacy Service Providers | Pharmacist | Psychiatric |
No ID Information.