Provider Demographics
NPI:1073341269
Name:HEALTHY LIVING AT 140 LLC
Entity type:Organization
Organization Name:HEALTHY LIVING AT 140 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-620-9544
Mailing Address - Street 1:140 ROUTE 10 STE 9
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1542
Mailing Address - Country:US
Mailing Address - Phone:973-620-9544
Mailing Address - Fax:973-620-9545
Practice Address - Street 1:140 ROUTE 10 STE 9
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1542
Practice Address - Country:US
Practice Address - Phone:973-620-9544
Practice Address - Fax:973-620-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy