Healthcare Provider Details

I. General information

NPI: 1063836435
Provider Name (Legal Business Name): SUSAN VARUGHESE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19081 GOLDENWEST ST
HUNTINGTON BEACH CA
92648-2151
US

IV. Provider business mailing address

19081 GOLDENWEST ST
HUNTINGTON BEACH CA
92648-2151
US

V. Phone/Fax

Practice location:
  • Phone: 714-960-3102
  • Fax: 714-960-2893
Mailing address:
  • Phone: 714-960-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number48961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: