Healthcare Provider Details

I. General information

NPI: 1316043573
Provider Name (Legal Business Name): HUDACKO'S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 BROADWAY
BAYONNE NJ
07002-3031
US

IV. Provider business mailing address

861 BROADWAY
BAYONNE NJ
07002-3031
US

V. Phone/Fax

Practice location:
  • Phone: 201-436-4488
  • Fax: 201-436-0240
Mailing address:
  • Phone: 201-436-4488
  • Fax: 201-436-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number28RS00219000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00219000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RS00219000
License Number StateNJ

VIII. Authorized Official

Name: BRIAN HOST
Title or Position: OWNER
Credential:
Phone: 201-436-4488