| Doctor Name: | MR. SIBY THOMAS PUTHENPURAYIL |
| NPI Number: | 1003181033 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPH |
| License Number: | PS42494 |
| Business Practice Address: | 4073 13th St Saint Cloud, FL - 347696701 |
| Business Phone Number: | 4075932959 |
| Business Fax Number: | 4075932957 |
| Mailing Address: | 4073 13th St, SAINT CLOUD |
| State: | FL |
| Postal Code: | 347696701 |
| Phone Number: | 4075932959 |
| Fax Number: | 4075932957 |
| NPI Enumeration Date: | 03/08/2012 |
| NPI Last Update Date: | 03/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835G0303X |
| License Number: | PS42494 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Geriatric |
| Taxonomy Definition: | A pharmacist who is certified in geriatric pharmacy practice is designated as a |