Martin Drugs of Riverhead,Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

019246 Issued in NY

Legal business name

MARTIN DRUGS OF RIVERHEAD,INC

Practice address

849 Old Country Rd
Riverhead, NY 11901-2106

Phone

(631) 727-0550

Fax

(631) 727-3054

NPI assigned

Sep 29, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Rajendraprasad Venigalla, RPH

Title

Owner Pres

Phone

(347) 528-8893

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Tax ID family

Martin Drugs of Riverheadinc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Martin Drugs of Riverhead,Inc

  • Long Term Care Pharmacy
  • Riverhead, NY
  • NPI 1649967266
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Haneesha Goli

  • Pharmacist
  • Riverhead, NY
  • NPI 1619421682
  NPD (past)
• Demetrios Michaelides

  • Pharmacist
  • Riverhead, NY
  • NPI 1730508516
  NPD (past)
• Thomas S Serio, RPH

  • Pharmacist
  • Riverhead, NY
  • NPI 1598896573
  NPD (past)

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586736000000",
    "number": "1053308684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "849 OLD COUNTRY RD",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012106",
            "telephone_number": "631-727-0550",
            "fax_number": "631-727-3054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "849 OLD COUNTRY RD",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012106",
            "telephone_number": "631-727-0550",
            "fax_number": "631-727-3054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN DRUGS OF RIVERHEAD,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A",
        "authorized_official_last_name": "VENIGALLA",
        "authorized_official_first_name": "RAJENDRAPRASAD",
        "authorized_official_title_or_position": "OWNER PRES",
        "authorized_official_telephone_number": "347-528-8893",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "019246",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00999440",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE REGISTRATION",
            "identifier": "019246",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "33-43340",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Marino, L.C.S.W.
• Mark J Coronel MD PC
• Glen Robert Mark, D.C.
• Nancy Szendy Mark, D.C.
• Nicole Marie Marky, NP
• Martin Drugs of Riverhead,Inc
• Mary Kathleen Martin, ANP
• Kenneth Martone
• Mary Kathleen Martin Nurse Practitioner in Psychiatry, PLLC
• Maryhaven Center of Hope

• Pharmacy in Riverhead, NY
• Providers in Riverhead, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.