Provider Demographics
NPI:1508150137
Name:VARUGHESE, SONNY (RPH)
Entity Type:Individual
Prefix:MR
First Name:SONNY
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 VALLEYVIEW PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5534
Mailing Address - Country:US
Mailing Address - Phone:718-761-6847
Mailing Address - Fax:718-218-8591
Practice Address - Street 1:555 VALLEYVIEW PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5534
Practice Address - Country:US
Practice Address - Phone:718-761-6847
Practice Address - Fax:718-218-8591
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037885-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist