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General NPI Number Information
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NPI Number | 1225158827
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Entity Type | Individual
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Provider Name | MR. VENKATA R KOGANTI
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 104 DEKALB AVE
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City | BROOKLYN
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State | NY
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Zip | 11201-5427
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Country | US
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Telephone | 718-250-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 4 DANDELION LN
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City | HOLMDEL
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State | NJ
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Zip | 07733-1474
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Country | US
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Telephone | 718-250-0060
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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 | 048288
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License Number State | NY
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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 | 21400
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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 | 13958
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License Number State | MD
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