Provider Demographics
NPI:1487043790
Name:VARUGHESE, SUSY KUNNODY
Entity Type:Individual
Prefix:
First Name:SUSY
Middle Name:KUNNODY
Last Name:VARUGHESE
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 1:719 S SR 19
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-328-6787
Mailing Address - Fax:386-328-8641
Practice Address - Street 1:719 S STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3946
Practice Address - Country:US
Practice Address - Phone:386-328-6787
Practice Address - Fax:386-328-8641
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist