MEDICARE: HALEY NIKOLAENKO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1-113268	KS
2	183500000X	Pharmacist	2024033784	MO
3	183500000X	Pharmacist	PS68690	FL

General Provider Information

NPI Number	:	1700717329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY NIKOLAENKO PHARMD

Provider Business Mailing Address
First Line	:	635 E NEW HAVEN AVE STE 814
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-5550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 HICKORY ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3224
Country	:	US
Telephone Number	:	321-434-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “ HALEY NIKOLAENKO PHARMD” Practice Location

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