MEDICARE: VVV RX INC,

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	025366	NY

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	:	1811922388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VVV RX INC,

Provider Business Mailing Address
First Line	:	112 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5429
Country	:	US
Telephone Number	:	718-250-0060
Fax Number	:	718-852-0469

Provider Business Practice Location Address
First Line	:	112 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5429
Country	:	US
Telephone Number	:	718-250-0060
Fax Number	:	718-852-0469

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	VENKATA KOGANTI
Credential	:
Telephone Number	:	718-250-0060

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/14/2024

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Directions to “VVV RX INC, ” Practice Location

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