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Organization
HAVILAND PHARMACY INC
Active
Organization
HAVILAND PHARMACY INC
Active
Other names
East Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARTHA JEAN JOLLY RPH (RPH OWNER)
(845) 229-2195
Entity
Organization
Contact information
Practice address
874 VIOLET AVE, HYDE PARK, NY 12538
(845) 229-2195
(845) 229-8700
Mailing address
874 VIOLET AVE, HYDE PARK, NY 12538
(845) 229-2195
(845) 229-8700
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
017019
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00768901
—
NY
01
—
3352755
NCPDP
—
Enumeration date
12/23/2005
Last updated
08/22/2020
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