=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902789928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALO HEALTH PHARMACY INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 459 E 149TH ST STE A104
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10455-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-381-8350
-----------------------------------------------------
Fax | 212-381-8351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 459 E 149TH ST STE A104
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10455-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-381-8350
-----------------------------------------------------
Fax | 212-381-8351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-873-5173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------