Provider Demographics
NPI:1356672091
Name:MBURU, MUTHIARU MUGETHE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MUTHIARU
Middle Name:MUGETHE
Last Name:MBURU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10157 PLEASURE CREEK PKWY W
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4223
Mailing Address - Country:US
Mailing Address - Phone:612-532-9346
Mailing Address - Fax:763-390-1024
Practice Address - Street 1:12480 ABERDEEN ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4721
Practice Address - Country:US
Practice Address - Phone:763-862-6596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1186451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist