Healthcare Provider Details

I. General information

NPI: 1144472358
Provider Name (Legal Business Name): VARGHESE K THOMAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BROADWAY
NEWYORK NY
10031
US

IV. Provider business mailing address

3415 BROADWAY
NEWYORK NY
10031
US

V. Phone/Fax

Practice location:
  • Phone: 212-283-6623
  • Fax: 212-283-5764
Mailing address:
  • Phone: 212-283-6623
  • Fax: 212-283-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0391221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: