Provider Demographics
NPI:1053899104
Name:MOHAWK VALLEY DRUGS LLC
Entity type:Organization
Organization Name:MOHAWK VALLEY DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALLIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-790-5418
Mailing Address - Street 1:635 BLANDINA ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:635 BLANDINA ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3144
Practice Address - Country:US
Practice Address - Phone:315-790-5418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies