Provider Demographics
NPI:1316966591
Name:HEALTHY PHARMACY INC
Entity type:Organization
Organization Name:HEALTHY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-966-8682
Mailing Address - Street 1:108 BOWERY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4788
Mailing Address - Country:US
Mailing Address - Phone:212-966-8682
Mailing Address - Fax:
Practice Address - Street 1:108 BOWERY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4788
Practice Address - Country:US
Practice Address - Phone:212-966-8682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY026567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5127930001Medicare NSC