Provider Demographics
NPI:1497277339
Name:NEW HAVEN HEALTH-AID PHARMACY LLC
Entity Type:Organization
Organization Name:NEW HAVEN HEALTH-AID PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LADAWN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:740-645-4941
Mailing Address - Street 1:307 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:WV
Mailing Address - Zip Code:25265-4100
Mailing Address - Country:US
Mailing Address - Phone:304-882-2005
Mailing Address - Fax:
Practice Address - Street 1:307 5TH ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:WV
Practice Address - Zip Code:25265
Practice Address - Country:US
Practice Address - Phone:304-882-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy