Provider Demographics
NPI:1982769030
Name:HEALTHY DRUGSTORE, INC
Entity Type:Organization
Organization Name:HEALTHY DRUGSTORE, INC
Other - Org Name:RIVERGATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOCITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-375-7711
Mailing Address - Street 1:PO BOX 4029
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-4029
Mailing Address - Country:US
Mailing Address - Phone:970-375-7711
Mailing Address - Fax:970-375-7722
Practice Address - Street 1:575 RIVERGATE LANE
Practice Address - Street 2:SUITE 111
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-375-7711
Practice Address - Fax:970-375-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO592332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26784068Medicaid
CO0619342OtherNCPDP
CO0619342OtherNCPDP
CO0619342OtherNCPDP