Provider Demographics
NPI:1194395939
Name:VARGHESE, BETSY C
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:C
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25996 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4436
Mailing Address - Country:US
Mailing Address - Phone:586-774-1070
Mailing Address - Fax:586-774-6987
Practice Address - Street 1:25996 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4436
Practice Address - Country:US
Practice Address - Phone:586-774-1070
Practice Address - Fax:586-774-6987
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303007358183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician