Haviland Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

017019 Issued in NY

Legal business name

HAVILAND PHARMACY INC

Practice address

874 Violet Ave
Hyde Park, NY 12538

Phone

(845) 229-2195

Fax

(845) 229-8700

NPI assigned

Dec 23, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Martha Jean Jolly, RPH

Title

RPH Owner

Phone

(845) 229-2195

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• East Park Pharmacy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295712966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "874 VIOLET AVE",
            "city": "HYDE PARK",
            "state": "NY",
            "postal_code": "12538",
            "telephone_number": "845-229-2195",
            "fax_number": "845-229-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 VIOLET AVE",
            "city": "HYDE PARK",
            "state": "NY",
            "postal_code": "12538",
            "telephone_number": "845-229-2195",
            "fax_number": "845-229-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVILAND PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOLLY",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "RPH OWNER",
        "authorized_official_telephone_number": "845-229-2195",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "017019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00768901",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3352755",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Park Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bianca Hagedorn, PA
• Mera Halloway, LCSW
• Christian Hanckel, LMT
• Tammy Marie Hanson, LPN
• Christian James Harmuth, RPH
• Health Quest Medical Practice, PC
• Health Quest Medical Practice, PC
• Health Quest Medical Practice, PC
• Patricia Ann Heidemann, R.N.
• Leeann Hejnal, LMHC-D

• Pharmacy in Hyde Park, NY
• Providers in Hyde Park, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.