Provider Demographics
NPI:1366463952
Name:HALCO PHARMACY,INC
Entity Type:Organization
Organization Name:HALCO PHARMACY,INC
Other - Org Name:MITTMAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
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:11211-5467
Mailing Address - Country:US
Mailing Address - Phone:718-384-2387
Mailing Address - Fax:718-384-2387
Practice Address - Street 1:167 HAVEMEYER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5467
Practice Address - Country:US
Practice Address - Phone:718-384-2387
Practice Address - Fax:718-384-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0167443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016744OtherSTATE LICENSE NUMBER
NY00451510Medicaid
NYAH9210561OtherDEA NUMBER
NY1258940001Medicare ID - Type Unspecified