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General NPI Number Information
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NPI Number | 1376894279
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Entity Type | Organization
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Legal Business Name | MOLLOY MEDICAL ARTS PHARMA INC
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 19 BAKER AVE STE 207 STE 207
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-1375
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Country | US
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Telephone | 845-471-7455
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Fax | 845-473-6337
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Provider Business Mailing Address
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Address Line | 19 BAKER AVE STE 207
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601
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Country | US
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Telephone | 845-471-7455
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Fax | 845-473-6337
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | GANESH KRISHNACHAND TALASILA
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Credential |
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Telephone | 845-471-7455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 031697
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License Number State | NY
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