Provider Demographics
NPI:1609436179
Name:VARUGHESE, SHIBU JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHIBU
Middle Name:JOHN
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 1:80 RIVERDALE AVE APT 8K
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3619
Mailing Address - Country:US
Mailing Address - Phone:914-396-6586
Mailing Address - Fax:
Practice Address - Street 1:2780 AIRPORT DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2289
Practice Address - Country:US
Practice Address - Phone:614-859-1939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014420183500000X
OH03438865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist