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General NPI Number Information
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NPI Number | 1295338036
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Entity Type | Individual
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Provider Name | DR. ALQUON HAILSTOCK
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Gender | Male
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 215 PARK AVE S
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City | NEW YORK
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State | NY
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Zip | 10003-1603
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Country | US
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Telephone | 646-602-8237
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Fax |
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Provider Business Mailing Address
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Address Line | 36 DECATUR ST
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City | BROOKLYN
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State | NY
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Zip | 11216-2504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 064977
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License Number State | NY
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