Healthcare Provider Details

I. General information

NPI: 1104143494
Provider Name (Legal Business Name): JAICY VARGHESE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BUSTLETON AVE RITE AID PHARMACY
PHILADELPHIA PA
19116
US

IV. Provider business mailing address

10610 SAINT THOMAS DR
PHILADELPHIA PA
19116-3890
US

V. Phone/Fax

Practice location:
  • Phone: 215-934-6221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP439830
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: