Provider Demographics
NPI:1326594318
Name:HEALTH MAX PHARMACY INC
Entity Type:Organization
Organization Name:HEALTH MAX PHARMACY INC
Other - Org Name:HEALTH MAX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-915-0952
Mailing Address - Street 1:2749 PITKIN AVENUE
Mailing Address - Street 2:2749 PITKIN AVENUE - BROOKLYN-NY-11208
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208
Mailing Address - Country:US
Mailing Address - Phone:347-915-0952
Mailing Address - Fax:718-975-4990
Practice Address - Street 1:2749 PITKIN AVE # 2
Practice Address - Street 2:2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3119
Practice Address - Country:US
Practice Address - Phone:347-915-0952
Practice Address - Fax:718-975-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0347483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163894OtherPK