Provider Demographics
NPI:1346655529
Name:VARGHESE, ANITA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 E 170TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-7015
Mailing Address - Country:US
Mailing Address - Phone:718-293-9596
Mailing Address - Fax:
Practice Address - Street 1:39 E 170TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-7015
Practice Address - Country:US
Practice Address - Phone:718-293-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045039-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist