Provider Demographics
NPI:1154197432
Name:HEALTHVILLE PHARMACY LLC
Entity type:Organization
Organization Name:HEALTHVILLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:KELVIN
Authorized Official - Last Name:BUSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-701-3349
Mailing Address - Street 1:7215 MCPHERSON RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6554
Mailing Address - Country:US
Mailing Address - Phone:956-701-3349
Mailing Address - Fax:956-701-3497
Practice Address - Street 1:7215 MCPHERSON RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6554
Practice Address - Country:US
Practice Address - Phone:956-701-3349
Practice Address - Fax:956-701-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy