Provider Demographics
NPI:1417209578
Name:MOLLOY PHARMA INC
Entity Type:Organization
Organization Name:MOLLOY PHARMA INC
Other - Org Name:MOLLOY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALUVADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-229-8881
Mailing Address - Street 1:4170 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1762
Mailing Address - Country:US
Mailing Address - Phone:845-229-8881
Mailing Address - Fax:845-229-8948
Practice Address - Street 1:4170 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1762
Practice Address - Country:US
Practice Address - Phone:845-229-8881
Practice Address - Fax:845-229-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0316963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03570569Medicaid
2139792OtherPK
NY031696OtherSTATE BOARD
NY5807372OtherNCPDP
NY5807372OtherNCPDP
NY5807372OtherNCPDP