Provider Demographics
NPI:1699959825
Name:MAMPALLIL, ANITHA VARGHESE (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANITHA
Middle Name:VARGHESE
Last Name:MAMPALLIL
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 1:34 QUENTIN CHARLTON TER
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1642
Mailing Address - Country:US
Mailing Address - Phone:914-375-0955
Mailing Address - Fax:
Practice Address - Street 1:34 QUENTIN CHARLTON TER
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1642
Practice Address - Country:US
Practice Address - Phone:914-375-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist