Provider Demographics
NPI:1518682160
Name:PERUMAL, ANNAMALAI (RPH)
Entity Type:Individual
Prefix:
First Name:ANNAMALAI
Middle Name:
Last Name:PERUMAL
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 1:13636 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2432
Mailing Address - Country:US
Mailing Address - Phone:734-288-3115
Mailing Address - Fax:
Practice Address - Street 1:13636 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2432
Practice Address - Country:US
Practice Address - Phone:734-288-3115
Practice Address - Fax:734-288-0962
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI21197060749183500000X
MI5302036208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist