Provider Demographics
NPI:1063641488
Name:DAKSHINAMOORTHY, SURESHKUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SURESHKUMAR
Middle Name:
Last Name:DAKSHINAMOORTHY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 BAY PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2534
Mailing Address - Country:US
Mailing Address - Phone:989-762-6000
Mailing Address - Fax:989-792-6005
Practice Address - Street 1:3077 BAY PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2534
Practice Address - Country:US
Practice Address - Phone:989-762-6000
Practice Address - Fax:989-792-6005
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist