Provider Demographics
NPI:1598800971
Name:HEALTHY WAY PHARMACY PROF CORP
Entity Type:Organization
Organization Name:HEALTHY WAY PHARMACY PROF CORP
Other - Org Name:HEALTHY WAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARABYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-997-9420
Mailing Address - Street 1:7223 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2702
Mailing Address - Country:US
Mailing Address - Phone:818-997-9420
Mailing Address - Fax:818-997-9465
Practice Address - Street 1:7223 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2702
Practice Address - Country:US
Practice Address - Phone:818-997-9420
Practice Address - Fax:818-997-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46267333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPMA462670Medicaid
CA4766720001Medicare ID - Type Unspecified