Healthcare Provider Details

I. General information

NPI: 1790067775
Provider Name (Legal Business Name): VENUS M MIGNOGNI R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

IV. Provider business mailing address

17 PIHLMAN PL
CHATHAM NJ
07928-2706
US

V. Phone/Fax

Practice location:
  • Phone: 908-673-7190
  • Fax: 908-673-7396
Mailing address:
  • Phone: 973-635-4515
  • Fax: 908-673-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RIO2131600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: