Healthcare Provider Details

I. General information

NPI: 1255054433
Provider Name (Legal Business Name): HALLIE RENEE ZAGROCKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7290 55TH AVE E
BRADENTON FL
34203-8002
US

IV. Provider business mailing address

718 OLD QUARRY RD
BRADENTON FL
34212-2620
US

V. Phone/Fax

Practice location:
  • Phone: 941-727-8412
  • Fax: 941-727-8195
Mailing address:
  • Phone: 904-803-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPS64877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: