Provider Demographics
NPI:1265535520
Name:VARGAS, MONICA MICHELLE (RPH)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MICHELLE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6967 LANGSTON RD
Mailing Address - Street 2:
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-7940
Mailing Address - Country:US
Mailing Address - Phone:843-396-4431
Mailing Address - Fax:
Practice Address - Street 1:223 N JONES RD
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29114
Practice Address - Country:US
Practice Address - Phone:843-396-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist