Provider Demographics
NPI:1689847253
Name:ARUMUGAM, KUPPUSAMY (RPH)
Entity Type:Individual
Prefix:MR
First Name:KUPPUSAMY
Middle Name:
Last Name:ARUMUGAM
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 1:925 PROTANO LN
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3940
Mailing Address - Country:US
Mailing Address - Phone:914-698-1051
Mailing Address - Fax:914-698-1051
Practice Address - Street 1:55 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2103
Practice Address - Country:US
Practice Address - Phone:718-547-6860
Practice Address - Fax:718-547-1308
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030679OtherEDU.DEPT.PHARMACY