Provider Demographics
NPI:1497350375
Name:VARUGHESE, SUBIN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:SUBIN
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3092 HOLLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6221
Mailing Address - Country:US
Mailing Address - Phone:954-806-3315
Mailing Address - Fax:
Practice Address - Street 1:375 ROCKBRIDGE RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8225
Practice Address - Country:US
Practice Address - Phone:770-806-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50557183500000X
GARPH034271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist