Provider Demographics
NPI:1255054433
Name:ZAGROCKI, HALLIE RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HALLIE
Middle Name:RENEE
Last Name:ZAGROCKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 OLD QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2620
Mailing Address - Country:US
Mailing Address - Phone:904-803-9321
Mailing Address - Fax:
Practice Address - Street 1:7290 55TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-8002
Practice Address - Country:US
Practice Address - Phone:941-727-8412
Practice Address - Fax:941-727-8195
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS648773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy