Provider Demographics
NPI:1588114797
Name:VARGHESE, GEORGE (RPH)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:VARGHESE
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 1:13124 ROCKAWAY BLVD
Mailing Address - Street 2:PARK HEALTH PHARMACY
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2932
Mailing Address - Country:US
Mailing Address - Phone:718-322-3261
Mailing Address - Fax:718-322-3261
Practice Address - Street 1:13124 ROCKAWAY BLVD
Practice Address - Street 2:PARK HEALTH PHARMACY
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2932
Practice Address - Country:US
Practice Address - Phone:718-322-3261
Practice Address - Fax:718-322-3261
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist