MEDICARE: LEBY VARGHESE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15093	OK

General Provider Information

NPI Number	:	1750180931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEBY VARGHESE

Provider Business Mailing Address
First Line	:	2209 SW 104TH ST STE E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7551
Country	:	US
Telephone Number	:	405-676-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 SW 104TH ST STE E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7551
Country	:	US
Telephone Number	:	405-676-5300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	03/11/2025

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Directions to “ LEBY VARGHESE ” Practice Location

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