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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1982424073
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	:	SUPERVISING PHARMACIST
Name	:	MR. VENKATA R KOGANTI
Credential	:
Telephone Number	:	718-250-0060

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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