Provider Demographics
NPI:1760727416
Name:HEALTHLAND PHARMACY LLC
Entity Type:Organization
Organization Name:HEALTHLAND PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-299-9669
Mailing Address - Street 1:1979 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2568
Mailing Address - Country:US
Mailing Address - Phone:614-299-9669
Mailing Address - Fax:
Practice Address - Street 1:1979 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2568
Practice Address - Country:US
Practice Address - Phone:614-299-9669
Practice Address - Fax:614-299-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077869Medicaid