Provider Demographics
NPI:1417140161
Name:HEALTHY DRUGSTORE, INC
Entity Type:Organization
Organization Name:HEALTHY DRUGSTORE, INC
Other - Org Name:THREE SPRINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOCITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-355-6474
Mailing Address - Street 1:PO BOX 4029
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-4029
Mailing Address - Country:US
Mailing Address - Phone:626-355-6474
Mailing Address - Fax:626-355-6448
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:UNIT 204
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7310
Practice Address - Country:US
Practice Address - Phone:626-355-6474
Practice Address - Fax:626-355-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO700332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42839556Medicaid
CO5335250002Medicare NSC