Individual ProviderVenkata R KogantiPharmacistPharmacy Service ProvidersPractice Address104 Dekalb Ave, Brooklyn, NY 11201-5427(718) 250-0060PECOS EnrollmentBased on the most recent information from CMS, provider Venkata R Koganti does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1225158827Provider TypeIndividualFull NameKoganti, Venkata RTitleMr.GenderMaleSole ProprietorNoEnumeration Date3/29/2007Last Updated7/9/2007Contact InformationPractice LocationPractice Address104 Dekalb Ave, Brooklyn, NY 11201-5427Phone(718) 250-0060FaxUnlisted FaxMailing LocationMailing Address4 Dandelion Ln, Holmdel, NJ 07733-1474Phone(718) 250-0060FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense048288New YorkCode183500000XDescriptionPharmacistPharmacy Service ProvidersLicense21400New JerseyCode183500000XDescriptionPharmacistPharmacy Service ProvidersLicense13958MarylandProvider IdentifiersIDDescriptionIssuerID02311379DescriptionMedicaidIssuerUnlistedMaryland