Provider Demographics
NPI:1528349164
Name:VARUGHESE, RENJI (PHARM D)
Entity type:Individual
Prefix:
First Name:RENJI
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 VICTORIA MANOR LN
Mailing Address - Street 2:APT #302
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2947
Mailing Address - Country:US
Mailing Address - Phone:954-240-0890
Mailing Address - Fax:
Practice Address - Street 1:3520 VICTORIA MANOR LN
Practice Address - Street 2:APT #302
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2947
Practice Address - Country:US
Practice Address - Phone:954-240-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist