MEDICARE: RAJENDRAPRASAD VENIGALLA PHARMACIST

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	041195	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041195	OTHER	NY	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1942457049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJENDRAPRASAD VENIGALLA PHARMACIST

Provider Business Mailing Address
First Line	:	5 EVERGREEN WAY
Second Line	:
City	:	GLEN HEAD
State	:	NY
Zip	:	11545-2541
Country	:	US
Telephone Number	:	347-528-8893
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2170
Country	:	US
Telephone Number	:	718-399-8677
Fax Number	:

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

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	12/16/2024

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