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General NPI Number Information
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NPI Number | 1558900308
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Entity Type | Individual
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Provider Name | ROBERT H HALLORAN
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Gender | Male
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Dates
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Enumeration Date | 12/26/2019
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 41 PARK PLZ
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City | MECHANICVILLE
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State | NY
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Zip | 12118-1520
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Country | US
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Telephone | 518-664-7320
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Fax |
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Provider Business Mailing Address
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Address Line | 10205 ROCKAWAY ST
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City | BALLSTON SPA
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State | NY
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Zip | 12020-5224
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Country | US
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Telephone | 518-366-8616
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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 | 064553
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License Number State | NY
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