Provider Demographics
NPI:1740394634
Name:LARKE DRUGS INC
Entity Type:Organization
Organization Name:LARKE DRUGS INC
Other - Org Name:110 PHARMACY AND SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDRAPRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:VENIGALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-421-5454
Mailing Address - Street 1:459 ROUTE 110
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2106
Mailing Address - Country:US
Mailing Address - Phone:631-421-5454
Mailing Address - Fax:631-421-0437
Practice Address - Street 1:459 ROUTE 110
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2106
Practice Address - Country:US
Practice Address - Phone:631-421-5454
Practice Address - Fax:631-421-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0162813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00738936Medicaid
2057346OtherPK
NY00738936Medicaid