Provider Demographics
NPI:1508939778
Name:VARGO PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:VARGO PHARMACY SERVICES, LLC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:267-994-1279
Mailing Address - Street 1:5924 TILGHMAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5924 TILGHMAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-336-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4816013336C0003X
PA3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017798100001Medicaid
3987370OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3987370OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1017798100001Medicaid
PA5808200001Medicare NSC