Provider Demographics
NPI:1417295437
Name:NORTH STATE HEALTHY SOLUTIONS LLC
Entity Type:Organization
Organization Name:NORTH STATE HEALTHY SOLUTIONS LLC
Other - Org Name:HALDEY PHARMACEUTICAL COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-610-8975
Mailing Address - Street 1:3619 PROVOST AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-6145
Mailing Address - Country:US
Mailing Address - Phone:646-350-0033
Mailing Address - Fax:855-326-6768
Practice Address - Street 1:3619 PROVOST AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-6145
Practice Address - Country:US
Practice Address - Phone:646-350-0033
Practice Address - Fax:855-326-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03548189Medicaid