Provider Demographics
NPI:1902245947
Name:GOOD HEALTH PHARMACY INC
Entity Type:Organization
Organization Name:GOOD HEALTH PHARMACY INC
Other - Org Name:GOOD HEALTH PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MARYAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-296-7000
Mailing Address - Street 1:7928 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1801
Mailing Address - Country:US
Mailing Address - Phone:718-296-7000
Mailing Address - Fax:718-296-7001
Practice Address - Street 1:7928 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1801
Practice Address - Country:US
Practice Address - Phone:718-296-7000
Practice Address - Fax:718-296-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X, 3336M0002X, 3336M0003X, 3336S0011X
NY0320283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03694337Medicaid
2140994OtherPK
NY03694337Medicaid