Provider Demographics
NPI:1033387667
Name:HALLERAN, CATHERINE (BS)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:HALLERAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4129
Mailing Address - Country:US
Mailing Address - Phone:631-665-8249
Mailing Address - Fax:631-665-8884
Practice Address - Street 1:1401 5TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4129
Practice Address - Country:US
Practice Address - Phone:631-665-8249
Practice Address - Fax:631-665-8884
Is Sole Proprietor?:No
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist