Provider Demographics
NPI:1770194649
Name:VARGO, MICHAEL SETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SETH
Last Name:VARGO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 NW 36TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8431
Mailing Address - Country:US
Mailing Address - Phone:515-346-3335
Mailing Address - Fax:
Practice Address - Street 1:260 NW 36TH ST STE 105
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8431
Practice Address - Country:US
Practice Address - Phone:515-346-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-109200183500000X
IA24696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-109200OtherPHARMACIST STATE LICENSE