=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891099602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANILA VARGHESE PHARM D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2011
-----------------------------------------------------
Last Update Date | 03/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2474 HEMPSTEAD TPKE
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-731-2483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2474 HEMPSTEAD TPKE
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-731-2483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 055311
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------