Provider Demographics
NPI:1851833693
Name:HEALTHY FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:HEALTHY FAMILY PHARMACY INC
Other - Org Name:HEALTHY FAMILY PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-992-2368
Mailing Address - Street 1:5901 8TH AVE
Mailing Address - Street 2:STORE #1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3294
Mailing Address - Country:US
Mailing Address - Phone:718-676-7733
Mailing Address - Fax:718-676-7675
Practice Address - Street 1:5901 8TH AVE
Practice Address - Street 2:STORE #1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3294
Practice Address - Country:US
Practice Address - Phone:718-676-7733
Practice Address - Fax:718-676-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0349253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166258OtherPK