Provider Demographics
NPI:1609202597
Name:HEALING PHARMACY
Entity Type:Organization
Organization Name:HEALING PHARMACY
Other - Org Name:HEALING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:SOBHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NADA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-758-6928
Mailing Address - Street 1:17860 SE 109TH AVE
Mailing Address - Street 2:STE. 616A
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8911
Mailing Address - Country:US
Mailing Address - Phone:352-693-2773
Mailing Address - Fax:352-693-2806
Practice Address - Street 1:17860 SE 109TH AVE STE 616A
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8909
Practice Address - Country:US
Practice Address - Phone:352-693-2773
Practice Address - Fax:352-693-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH268073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142202OtherPK