=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770828550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAL THE WORLD PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2012
-----------------------------------------------------
Last Update Date | 02/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16145 BAISLEY BLVD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11434-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-276-4325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16145 BAISLEY BLVD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11434-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-276-4325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/SUPERVISING PHARMACIST
-----------------------------------------------------
Name | ISAAK R PINKHASOV
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 917-421-2490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 031579
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------