Provider Demographics
NPI:1508141037
Name:SENTHILKUMAR, PANCHACHRAM (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:PANCHACHRAM
Middle Name:
Last Name:SENTHILKUMAR
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 1:502 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3640
Mailing Address - Country:US
Mailing Address - Phone:810-424-9270
Mailing Address - Fax:
Practice Address - Street 1:502 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3640
Practice Address - Country:US
Practice Address - Phone:810-424-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist