Provider Demographics
NPI:1467070847
Name:MARIMUTHU, SURESH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:MARIMUTHU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5962
Mailing Address - Country:US
Mailing Address - Phone:561-855-7802
Mailing Address - Fax:561-899-3614
Practice Address - Street 1:2939 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5962
Practice Address - Country:US
Practice Address - Phone:561-855-7802
Practice Address - Fax:561-899-3614
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty