Provider Demographics
NPI:1336417922
Name:ABRAHAM, VINI ANIL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VINI
Middle Name:ANIL
Last Name:ABRAHAM
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 1:113-131 WEST WYOMING AVENUE
Mailing Address - Street 2:RITE AID PHARMACY 2564
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-0000
Mailing Address - Country:US
Mailing Address - Phone:215-329-1516
Mailing Address - Fax:
Practice Address - Street 1:113-131 WEST WYOMING AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-0000
Practice Address - Country:US
Practice Address - Phone:215-329-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist