Provider Demographics
NPI:1578075677
Name:HUDACKO'S PHARMACY INC
Entity Type:Organization
Organization Name:HUDACKO'S PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:HALECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-436-4488
Mailing Address - Street 1:861 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3031
Mailing Address - Country:US
Mailing Address - Phone:201-436-4488
Mailing Address - Fax:
Practice Address - Street 1:861 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3031
Practice Address - Country:US
Practice Address - Phone:201-436-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0033774Medicaid