Provider Demographics
NPI:1003190877
Name:VARGHESE, REENA ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:ELIZABETH
Last Name:VARGHESE
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 1:3825 DURAND AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4424
Mailing Address - Country:US
Mailing Address - Phone:262-554-8686
Mailing Address - Fax:262-554-0744
Practice Address - Street 1:3825 DURAND AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4424
Practice Address - Country:US
Practice Address - Phone:262-554-8686
Practice Address - Fax:262-554-0744
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist