Paak Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

033702 Issued in NY

Legal business name

PAAK PHARMACY INC

Doing business as

112 Pharmacy & Surgical

Practice address

689 Medford Ave
Patchogue, NY 11772-1347

Phone

(631) 289-2468

Fax

(631) 307-9360

NPI assigned

Sep 3, 2015

Last updated

Jan 27, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rajendraprasad VenigallaNPI 1942457049

Title

Secretary

Phone

(347) 528-8893

Specialties & licenses 3

Addresses

Other names 1

• 112 PHARMACY & SURGICAL Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rajendraprasad Venigalla, PHARMACIST

  • Pharmacist
  • Brooklyn, NY
  • NPI 1942457049
  Authorized official Same address or phone
• Joanna Marie Haff, PHARMD

  • Pharmacist
  • East Patchogue, NY
  • NPI 1609355874
  NPD (past)
• Paulitha Pasala

  • Pharmacist
  • Patchogue, NY
  • NPI 1679025456
  NPD (past)

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

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1780052001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "689 MEDFORD AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721347",
            "telephone_number": "631-289-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "689 MEDFORD AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721347",
            "telephone_number": "631-289-2468",
            "fax_number": "631-307-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAAK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-03",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "VENIGALLA",
        "authorized_official_first_name": "RAJENDRAPRASAD",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "347-528-8893"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "033702",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "112 PHARMACY & SURGICAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "112 PHARMACY & SURGICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Orthopedic Associates of Long Island, LLC
• Fiona Melissa Ortiz
• Jill J Ottaviano
• Linda Overton
• P.T.C Medical, P.C.
• Barbara Pagliaro, CASAC
• Gregory Steven Pahlavi, PA-C
• Diana Palladino, RN
• Jamie Palm, LMHC, CRC
• Jocelyn Makena Pannacchione, NP

• Community/Retail Pharmacy in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.