Provider Demographics
NPI:1194025924
Name:VENIGALLA, SWAPNA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SWAPNA
Middle Name:
Last Name:VENIGALLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OAKWOOD VLG APT 4
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9023
Mailing Address - Country:US
Mailing Address - Phone:973-462-6954
Mailing Address - Fax:
Practice Address - Street 1:23 OAKWOOD VLG APT 4
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9023
Practice Address - Country:US
Practice Address - Phone:973-462-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03134500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist