Provider Demographics
NPI:1538482492
Name:HALLENBECK, WILLIAM M (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:HALLENBECK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1667
Mailing Address - Country:US
Mailing Address - Phone:607-772-0656
Mailing Address - Fax:607-772-3872
Practice Address - Street 1:50 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1667
Practice Address - Country:US
Practice Address - Phone:607-772-0656
Practice Address - Fax:607-772-3872
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist