Provider Demographics
NPI:1306021308
Name:PEPE, VANESSA (RPH)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PEPE
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 1:10813 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2243
Mailing Address - Country:US
Mailing Address - Phone:718-441-7711
Mailing Address - Fax:212-888-3545
Practice Address - Street 1:10813 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2243
Practice Address - Country:US
Practice Address - Phone:718-441-7711
Practice Address - Fax:718-441-2018
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0895538Medicaid