MEDICARE: MR. VENKATA R KOGANTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	048288	NY
2	183500000X	Pharmacist	21400	NJ
3	183500000X	Pharmacist	13958	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225158827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VENKATA R KOGANTI

Provider Business Mailing Address
First Line	:	4 DANDELION LN
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1474
Country	:	US
Telephone Number	:	718-250-0060
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5427
Country	:	US
Telephone Number	:	718-250-0060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/09/2007

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