MEDICARE: HEALTHY HEIGHTS PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	035993	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	7682340001	OTHER	NY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2175245	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164939195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY HEIGHTS PHARMACY INC

Provider Business Mailing Address
First Line	:	1370 ST NICHOLAS AVE STORE #2
Second Line	:
City	:	MANHATTAN
State	:	NY
Zip	:	10033
Country	:	US
Telephone Number	:	212-928-1999
Fax Number	:	212-928-1995

Provider Business Practice Location Address
First Line	:	1370 SAINT NICHOLAS AVE STORE #2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-6227
Country	:	US
Telephone Number	:	212-928-1999
Fax Number	:	212-928-1995

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN MUSHEYEV
Credential	:
Telephone Number	:	212-928-1999

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	03/21/2022

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Directions to “HEALTHY HEIGHTS PHARMACY INC ” Practice Location

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