Provider Demographics
NPI:1730458803
Name:VARGHESE, GEORGE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3110
Mailing Address - Country:US
Mailing Address - Phone:404-421-2500
Mailing Address - Fax:
Practice Address - Street 1:1708 PUCKETTS DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5617
Practice Address - Country:US
Practice Address - Phone:404-421-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052403-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052403-1OtherPHARMACIST