Provider Demographics
NPI:1750985180
Name:VARUGHESE, GREETEL
Entity type:Individual
Prefix:
First Name:GREETEL
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 ARISTA BLVD APT 125
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1197
Mailing Address - Country:US
Mailing Address - Phone:713-382-7284
Mailing Address - Fax:
Practice Address - Street 1:200 WAKE VILLAGE RD
Practice Address - Street 2:
Practice Address - City:WAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75501-6227
Practice Address - Country:US
Practice Address - Phone:903-716-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist