Provider Demographics
NPI:1164939195
Name:HEALTHY HEIGHTS PHARMACY INC
Entity Type:Organization
Organization Name:HEALTHY HEIGHTS PHARMACY INC
Other - Org Name:HEALTHY HEIGHTS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHEYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-928-1999
Mailing Address - Street 1:1370 ST NICHOLAS AVE STORE #2
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:NY
Mailing Address - Zip Code:10033
Mailing Address - Country:US
Mailing Address - Phone:212-928-1999
Mailing Address - Fax:212-928-1995
Practice Address - Street 1:1370 SAINT NICHOLAS AVE STORE #2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6227
Practice Address - Country:US
Practice Address - Phone:212-928-1999
Practice Address - Fax:212-928-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0359933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175245OtherPK
NY05266399Medicaid
NY7682340001OtherMEDICARE