MEDICARE: SUSAN VARUGHESE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	48961	CA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	48961	CA

General Provider Information

NPI Number	:	1063836435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN VARUGHESE RPH

Provider Business Mailing Address
First Line	:	3380 N LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 N LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3916
Country	:	US
Telephone Number	:	562-425-9673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	10/14/2020

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