Provider Demographics
NPI:1336282680
Name:HEALTHY WAY PHARMACY INC
Entity Type:Organization
Organization Name:HEALTHY WAY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-738-9790
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:KY
Mailing Address - Zip Code:41171-0492
Mailing Address - Country:US
Mailing Address - Phone:606-738-4041
Mailing Address - Fax:606-738-4030
Practice Address - Street 1:432 S KY 7
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171-8132
Practice Address - Country:US
Practice Address - Phone:606-738-4041
Practice Address - Fax:606-738-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYPO64123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90030321Medicaid
KY54033865Medicaid
KY54033865Medicaid