Healthcare Provider Details

I. General information

NPI: 1477318293
Provider Name (Legal Business Name): HEALTH HEAVEN RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N WOOD AVE
LINDEN NJ
07036-4145
US

IV. Provider business mailing address

422 N WOOD AVE
LINDEN NJ
07036-4145
US

V. Phone/Fax

Practice location:
  • Phone: 908-583-6665
  • Fax: 888-474-0976
Mailing address:
  • Phone: 908-583-6665
  • Fax: 888-474-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHIEDOZIE CHUKWUNEKE
Title or Position: PHARMACIST-IN-CHARGE
Credential:
Phone: 908-583-6665