Healthcare Provider Details

I. General information

NPI: 1114774536
Provider Name (Legal Business Name): ANNCY VARGHESE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

8425 RIDGEWAY AVE
SKOKIE IL
60076-2855
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-4319
  • Fax:
Mailing address:
  • Phone: 847-846-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051.298074
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: