Basic Information
| Provider Information | |||||||||
| NPI: | 1124220348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARUGHESE | ||||||||
| FirstName: | SHEEBA | ||||||||
| MiddleName: | KAVATTU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10180 DOUBLETREE DR N | ||||||||
| Address2: | |||||||||
| City: | CROWN POINT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463079362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199738850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 GREEN BAY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600643048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2246104319 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 26020084A | IN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.