Provider Demographics
NPI:1164068060
Name:JOSEPH, VARGHESE M (RPH)
Entity Type:Individual
Prefix:
First Name:VARGHESE
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22332 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1972
Mailing Address - Country:US
Mailing Address - Phone:586-541-1042
Mailing Address - Fax:586-541-1044
Practice Address - Street 1:22332 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1972
Practice Address - Country:US
Practice Address - Phone:586-541-1042
Practice Address - Fax:586-541-1044
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020358581835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist