Provider Demographics
NPI:1053016410
Name:MOBY DRUGS INC
Entity type:Organization
Organization Name:MOBY DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJENDRAPRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:VENIGALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-528-8893
Mailing Address - Street 1:226 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2679
Mailing Address - Country:US
Mailing Address - Phone:516-249-0268
Mailing Address - Fax:516-249-2036
Practice Address - Street 1:226 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2679
Practice Address - Country:US
Practice Address - Phone:516-249-0268
Practice Address - Fax:516-249-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02974638Medicaid