Provider Demographics
NPI:1558535401
Name:SUBBIAH, SHANKAR THIRUTHURAIPOONDI
Entity Type:Individual
Prefix:
First Name:SHANKAR
Middle Name:THIRUTHURAIPOONDI
Last Name:SUBBIAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 GREYSTONE LN
Mailing Address - Street 2:APT 17
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8453
Mailing Address - Country:US
Mailing Address - Phone:989-779-0571
Mailing Address - Fax:
Practice Address - Street 1:1341 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1134
Practice Address - Country:US
Practice Address - Phone:989-463-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist