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Organization
MARTIN DRUGS OF RIVERHEAD,INC
Active
Organization
MARTIN DRUGS OF RIVERHEAD,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAJENDRAPRASAD VENIGALLA RPH (OWNER PRES)
(347) 528-8893
Entity
Organization
Contact information
Practice address
849 OLD COUNTRY RD, RIVERHEAD, NY 11901-2106
(631) 727-0550
(631) 727-3054
Mailing address
849 OLD COUNTRY RD, RIVERHEAD, NY 11901-2106
(631) 727-0550
(631) 727-3054
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
019246
NY
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00999440
—
NY
01
—
019246
STATE REGISTRATION
NY
01
—
33-43340
NCPDP
—
Enumeration date
09/29/2005
Last updated
04/13/2020
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