Provider Demographics
NPI:1619156155
Name:VARGAS, JULISSA (PHARMD,RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULISSA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 AMSTERDAM AVENUE
Mailing Address - Street 2:VENUS PHARMACY & SUPPLIES CORP.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-666-4800
Mailing Address - Fax:
Practice Address - Street 1:972 AMSTERDAM AVE
Practice Address - Street 2:VENUS PHARMACY & SUPPLIES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3002
Practice Address - Country:US
Practice Address - Phone:212-666-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist