Provider Demographics
NPI:1659112621
Name:HYD PHARMACY LLC
Entity type:Organization
Organization Name:HYD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ALESSANDRO
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:949-691-6519
Mailing Address - Street 1:527 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3630
Mailing Address - Country:US
Mailing Address - Phone:949-991-1355
Mailing Address - Fax:
Practice Address - Street 1:527 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3630
Practice Address - Country:US
Practice Address - Phone:949-991-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy