Provider Demographics
NPI:1316259963
Name:HEALTHFAVOR PHARMACY LLC
Entity type:Organization
Organization Name:HEALTHFAVOR PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OSINAKACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-461-9055
Mailing Address - Street 1:712 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3503
Mailing Address - Country:US
Mailing Address - Phone:484-461-9055
Mailing Address - Fax:484-461-9054
Practice Address - Street 1:712 CHURCH LN
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3503
Practice Address - Country:US
Practice Address - Phone:484-461-9055
Practice Address - Fax:484-461-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4820593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025230500001Medicaid
2127291OtherPK