Provider Demographics
NPI:1174551584
Name:HALL, GARY EUGENE (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:EUGENE
Last Name:HALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 SW MARQUAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1453
Mailing Address - Country:US
Mailing Address - Phone:503-222-1371
Mailing Address - Fax:
Practice Address - Street 1:PORTLAND VA MEDICAL CENTER
Practice Address - Street 2:3710 SW U.S. VETERANS HOSPITAL RD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6163183500000X
HI0588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist