Provider Demographics
NPI:1760162903
Name:CLAREST HEALTH 2903, LLC
Entity Type:Organization
Organization Name:CLAREST HEALTH 2903, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COMPLIANCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:631-359-9711
Mailing Address - Street 1:230 SEA LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3900
Mailing Address - Country:US
Mailing Address - Phone:631-359-9711
Mailing Address - Fax:631-212-5311
Practice Address - Street 1:4645 E COTTON CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8883
Practice Address - Country:US
Practice Address - Phone:480-810-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy