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General NPI Number Information
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NPI Number | 1174951784
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Entity Type | Individual
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Provider Name | VENUGOPAL GHANTA VENKATA PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1816 STEFKO BLVD STE A
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City | BETHLEHEM
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State | PA
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Zip | 18017-6235
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Country | US
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Telephone | 610-419-4198
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Fax | 610-419-4252
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Provider Business Mailing Address
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Address Line | 4965 HYCLIFF CHASE
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City | CENTER VALLEY
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State | PA
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Zip | 18034-8792
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Country | US
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Telephone | 646-522-4419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17542
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03053400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 057825
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP445355
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License Number State | PA
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