Provider Demographics
NPI:1962599167
Name:OCEAN PHARMACY INC
Entity type:Organization
Organization Name:OCEAN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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:516-764-9600
Mailing Address - Street 1:3124 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3299
Mailing Address - Country:US
Mailing Address - Phone:516-764-9600
Mailing Address - Fax:516-764-0218
Practice Address - Street 1:3124 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3299
Practice Address - Country:US
Practice Address - Phone:516-764-9600
Practice Address - Fax:516-764-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0296993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3302370OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY03318958Medicaid
FO 1662356OtherDEA
NY03318958Medicaid