Provider Demographics
NPI:1154814887
Name:HEAL N HALE LLC
Entity Type:Organization
Organization Name:HEAL N HALE LLC
Other - Org Name:WINTER PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:SHRUTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-636-4670
Mailing Address - Street 1:3090 ALOMA AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3743
Mailing Address - Country:US
Mailing Address - Phone:407-636-4670
Mailing Address - Fax:407-636-4671
Practice Address - Street 1:3090 ALOMA AVE STE 140
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3743
Practice Address - Country:US
Practice Address - Phone:407-636-4670
Practice Address - Fax:407-636-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH285483336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177832OtherPK
FL014285600Medicaid