Provider Demographics
NPI:1841567682
Name:HEALTHY FOR LIFE LLC
Entity Type:Organization
Organization Name:HEALTHY FOR LIFE LLC
Other - Org Name:SMILE PHARMACY AND SURGICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-986-6694
Mailing Address - Street 1:1110 HAMILTON BLVD
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2000
Mailing Address - Country:US
Mailing Address - Phone:908-756-3232
Mailing Address - Fax:908-756-3111
Practice Address - Street 1:1110 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2000
Practice Address - Country:US
Practice Address - Phone:908-756-3232
Practice Address - Fax:908-756-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007162003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131292OtherPK
3198303OtherNCPDP PROVIDER IDENTIFICATION NUMBER