MEDICARE: VENU GOGINENI

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	PS38801	FL

General Provider Information

NPI Number	:	1205431798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENU GOGINENI

Provider Business Mailing Address
First Line	:	8293 SILVER BIRCH WAY
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-3721
Country	:	US
Telephone Number	:	239-565-3049
Fax Number	:

Provider Business Practice Location Address
First Line	:	15050 N CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33903-2773
Country	:	US
Telephone Number	:	239-995-5461
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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Directions to “ VENU GOGINENI ” Practice Location

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