Provider Demographics
NPI:1790067775
Name:MIGNOGNI, VENUS M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VENUS
Middle Name:M
Last Name:MIGNOGNI
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 1:17 PIHLMAN PL
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2706
Mailing Address - Country:US
Mailing Address - Phone:973-635-4515
Mailing Address - Fax:908-673-7396
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-673-7190
Practice Address - Fax:908-673-7396
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO2131600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist