Healthcare Provider Details

I. General information

NPI: 1477733921
Provider Name (Legal Business Name): LINU SUSAN VARGHESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HEMPSTEAD TPKE
WEST HEMPSTEAD NY
11552-1125
US

IV. Provider business mailing address

500 HEMPSTEAD TPKE
WEST HEMPSTEAD NY
11552-1125
US

V. Phone/Fax

Practice location:
  • Phone: 516-538-4488
  • Fax: 516-538-3125
Mailing address:
  • Phone: 516-538-4488
  • Fax: 516-538-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: