Provider Demographics
NPI:1033533633
Name:VARUGHESE, SUJA MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUJA
Middle Name:MARY
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 GLEN COVE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-621-5959
Mailing Address - Fax:516-621-3184
Practice Address - Street 1:421 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1811
Practice Address - Country:US
Practice Address - Phone:516-621-5959
Practice Address - Fax:516-621-3184
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058613-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist