Provider Demographics
NPI:1619467651
Name:HEALTHY PHARMACY COMPANY
Entity Type:Organization
Organization Name:HEALTHY PHARMACY COMPANY
Other - Org Name:KITTSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOFTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-636-0021
Mailing Address - Street 1:1010 S BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56728
Mailing Address - Country:US
Mailing Address - Phone:218-843-3896
Mailing Address - Fax:218-843-3895
Practice Address - Street 1:1010 S BIRCH AVE
Practice Address - Street 2:
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728
Practice Address - Country:US
Practice Address - Phone:218-843-3896
Practice Address - Fax:218-843-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3336C0003X, 3336L0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy