MEDICARE: HEALTHY FORDHAM RX CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1255281259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY FORDHAM RX CORP

Provider Business Mailing Address
First Line	:	52 W FORDHAM RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5125
Country	:	US
Telephone Number	:	917-471-8868
Fax Number	:	917-471-8869

Provider Business Practice Location Address
First Line	:	52 W FORDHAM RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5125
Country	:	US
Telephone Number	:	917-471-8868
Fax Number	:	917-471-8869

Authorized Official
Title or Position	:	OWNER
Name	:	YELENA YAKUBOVA
Credential	:
Telephone Number	:	917-471-8868

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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