Organization
SPAGES PHARMACY INC
Active
Other names
Spages Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SAMBASIVA VENIGALLA RPH (PRESIDENT)
(631) 584-6460
Entity
Organization
Contact information
Practice address
471 LAKE AVE, SAINT JAMES, NY 11780-2209
(631) 584-6460
(631) 584-3478
Mailing address
471 LAKE AVE, SAINT JAMES, NY 11780-2209
(631) 584-6460
(631) 584-3478
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
029895
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03178498
—
NY
01
—
2123717
PK
—
Enumeration date
12/05/2006
Last updated
04/05/2018
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