Provider Demographics
NPI:1457417727
Name:GOOD HEALTH PHARMACY
Entity Type:Organization
Organization Name:GOOD HEALTH PHARMACY
Other - Org Name:GOOD HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-759-2761
Mailing Address - Street 1:530 JORALEMON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1844
Mailing Address - Country:US
Mailing Address - Phone:973-759-2761
Mailing Address - Fax:973-759-8322
Practice Address - Street 1:530 JORALEMON ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1844
Practice Address - Country:US
Practice Address - Phone:973-759-2761
Practice Address - Fax:973-759-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS004027003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4389506Medicaid
2057956OtherPK
NJ1319530001Medicare NSC