Provider Demographics
NPI:1962787390
Name:VARAHAMURTHY, SUJATA (BPHARM)
Entity type:Individual
Prefix:MRS
First Name:SUJATA
Middle Name:
Last Name:VARAHAMURTHY
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1747
Mailing Address - Country:US
Mailing Address - Phone:559-244-0974
Mailing Address - Fax:559-244-0980
Practice Address - Street 1:2420 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-244-0974
Practice Address - Fax:559-244-0980
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA046704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist