Provider Demographics
NPI:1326553124
Name:HALCORX PHARMACY INC
Entity Type:Organization
Organization Name:HALCORX PHARMACY INC
Other - Org Name:MITTMAN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:Q
Authorized Official - Last Name:JAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-384-2387
Mailing Address - Street 1:167 HAVEMEYER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5791
Mailing Address - Country:US
Mailing Address - Phone:718-384-2387
Mailing Address - Fax:
Practice Address - Street 1:167 HAVEMEYER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5791
Practice Address - Country:US
Practice Address - Phone:718-384-2387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0358543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A