Provider Demographics
NPI:1609378090
Name:KOGANTI, ARVIND
Entity Type:Individual
Prefix:
First Name:ARVIND
Middle Name:
Last Name:KOGANTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2628
Mailing Address - Country:US
Mailing Address - Phone:973-481-3388
Mailing Address - Fax:973-481-0625
Practice Address - Street 1:205 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2628
Practice Address - Country:US
Practice Address - Phone:973-481-3388
Practice Address - Fax:973-481-0625
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03925100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist