Provider Demographics
NPI:1477733921
Name:VARGHESE, LINU SUSAN
Entity Type:Individual
Prefix:
First Name:LINU
Middle Name:SUSAN
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1125
Mailing Address - Country:US
Mailing Address - Phone:516-538-4488
Mailing Address - Fax:516-538-3125
Practice Address - Street 1:500 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1125
Practice Address - Country:US
Practice Address - Phone:516-538-4488
Practice Address - Fax:516-538-3125
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist