Provider Demographics
NPI:1255038352
Name:VARGHESE, DANIEL MOSES THOMAS (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MOSES THOMAS
Last Name:VARGHESE
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 1:1191 SOUTH BLVD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5453
Mailing Address - Country:US
Mailing Address - Phone:800-456-2112
Mailing Address - Fax:
Practice Address - Street 1:1191 SOUTH BLVD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5453
Practice Address - Country:US
Practice Address - Phone:800-456-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024136891835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care