Telemedicine Model Compliance. Please clarify how the telemedicine model/modality provided by your company complies with the law of each state in the USA and/or international jurisdiction. Modality may include online questionnaire, video consultations, two way audio, store and forward technology, etc. : A questionnaire with medical evaluation of history and photos
Physician/Practitioner First and Last Name.
Please list the first and last name of the physician/practitioner employed or contracted by your company providing telemedicine services to patients in each applicable state or jurisdiction. : Herbert S Feinberg, M.D. Andrew Glen Woolrich, M.D.Physician/Practitioner Licensure Number. Please list the physician's/practitioner's licensure number for each state or jurisdiction. :Dr. Feinberg :25MA02042600 Dr Woolrich:25MA06074900
Physician/Practitioner Licensure Type : MD
Physician/Practitioner License Expiration Date (MM/DD/YYYY):
Dr. Feinberg EXP 06/30/2025
Dr. Woolrich EXP 06/30/2025
Pharmacy Name. Please list the pharmacy that is shipping drugs into each applicable state in the USA or international jurisdiction on behalf of your company. :HB Pharmacy
Pharmacy License Numbers.
Please list the pharmacy license numbers for each state in the USA or international jurisdiction each pharmacy ships to. : 28RS00010500
Pharmacy License Expiration Date (MM/DD/YYYY) : 04/30/2025
Pharmacist License - Name. Please list the name of the applicable pharmacist in charge for your pharmacy's home state and each state your pharmacy ships to: John C BellittiPharmacist License Number(PIC): 28RI01887100Pharmacist License
Expiration Date (MM/DD/YYYY): 06/30/2025
DEA License Number: Dr. Feinberg AF2619130, Dr. Woolrich FW4936235, HB Pharmacy D00422700DEA License Number Expiration Date (MM/DD/YYYY) :Dr. Feinberg 9/30/25 Dr. woolrich 5/31/26
Compounding / Dispensing Physicians. Please list all wholesalers utilized to supply active pharmaceutical ingredients to your clinic.: N/A
Compounding / Dispensing Physicians: Wholesaler licensure number for the state your clinic is located in: N/A
Compounding / Dispensing Physicians: Wholesaler Expiration Date (MM/DD/YYYY): N/A
HAIRMDL® and
HairMDL.com
363 Grand Avenue
Englewood, NJ 07631
Phone: 201-568-6977
Email:
info@hairmdl.com
