Provider Demographics
NPI:1821465220
Name:HEALTHVIA PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:HEALTHVIA PHARMACY SERVICES LLC
Other - Org Name:HEALTHVIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:856-983-8700
Mailing Address - Street 1:300 GREENTREE RD
Mailing Address - Street 2:#8
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9418
Mailing Address - Country:US
Mailing Address - Phone:856-983-8700
Mailing Address - Fax:856-983-8703
Practice Address - Street 1:300 GREENTREE RD STE 8
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9418
Practice Address - Country:US
Practice Address - Phone:856-983-8700
Practice Address - Fax:856-983-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007474003336C0003X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158649OtherPK
NJ0519031Medicaid
NJ7553800001Medicare NSC