Provider Demographics
NPI:1053619197
Name:HALL, ELIZABETH BUCKLEY (BS PHARM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BUCKLEY
Last Name:HALL
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HOPE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1415
Mailing Address - Country:US
Mailing Address - Phone:770-307-8200
Mailing Address - Fax:
Practice Address - Street 1:11855 JONES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5042
Practice Address - Country:US
Practice Address - Phone:770-521-1292
Practice Address - Fax:770-521-9024
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-13
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist