Provider Demographics
NPI:1134812282
Name:HEALTHY LIFE PHARMACY LLC
Entity type:Organization
Organization Name:HEALTHY LIFE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:573-734-8588
Mailing Address - Street 1:1013 CEDAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:MO
Mailing Address - Zip Code:63624-8901
Mailing Address - Country:US
Mailing Address - Phone:573-734-8588
Mailing Address - Fax:888-626-5925
Practice Address - Street 1:1013 CEDAR ST STE B
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:MO
Practice Address - Zip Code:63624-8901
Practice Address - Country:US
Practice Address - Phone:573-734-8588
Practice Address - Fax:888-626-5925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY LIFE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-02
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy