Provider Demographics
NPI:1003181033
Name:PUTHENPURAYIL, SIBY THOMAS (RPH)
Entity type:Individual
Prefix:MR
First Name:SIBY
Middle Name:THOMAS
Last Name:PUTHENPURAYIL
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 1:2801 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4134
Mailing Address - Country:US
Mailing Address - Phone:407-593-2959
Mailing Address - Fax:407-593-2957
Practice Address - Street 1:2801 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4134
Practice Address - Country:US
Practice Address - Phone:407-593-2959
Practice Address - Fax:407-593-2957
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS424941835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00356500Medicaid