Provider Demographics
NPI:1760538409
Name:HEALTHY CORNER PHARMACY INC
Entity Type:Organization
Organization Name:HEALTHY CORNER PHARMACY INC
Other - Org Name:HEALTHY CORNER PHARMACY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARABOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:718-261-6699
Mailing Address - Street 1:11665 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6533
Mailing Address - Country:US
Mailing Address - Phone:718-261-6699
Mailing Address - Fax:718-261-6689
Practice Address - Street 1:11665 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6533
Practice Address - Country:US
Practice Address - Phone:718-261-6699
Practice Address - Fax:718-261-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X
NY026927333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02594329Medicaid
NY5283030001Medicare ID - Type Unspecified