Provider Demographics
NPI:1043640550
Name:HALOCARE SPECIALTY THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:HALOCARE SPECIALTY THERAPEUTICS, LLC
Other - Org Name:PARAGON INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1000
Mailing Address - Street 1:34972 OLD LA HIGHWAY 16 STE A
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-0573
Mailing Address - Country:US
Mailing Address - Phone:225-791-4225
Mailing Address - Fax:225-243-7957
Practice Address - Street 1:34972 OLD LA HIGHWAY 16 STE A
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-0573
Practice Address - Country:US
Practice Address - Phone:225-791-4225
Practice Address - Fax:225-243-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X, 3336M0002X, 3336S0011X
LA0068423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2202511Medicaid
LAPHY044485OtherCDS
MS08679218Medicaid
LA7084150001Medicare NSC