Provider Demographics
NPI:1649621210
Name:VANKAWALA, ARUN (RPH)
Entity type:Individual
Prefix:MR
First Name:ARUN
Middle Name:
Last Name:VANKAWALA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4233
Mailing Address - Country:US
Mailing Address - Phone:215-927-0224
Mailing Address - Fax:215-927-0813
Practice Address - Street 1:204 STEEPLECHASE DR
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-4233
Practice Address - Country:US
Practice Address - Phone:215-927-0224
Practice Address - Fax:215-927-0813
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029205L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001057115Medicaid
PA1317970001Medicare NSC