Provider Demographics
NPI:1629367503
Name:MARU, BRIJESH SURESH (BPHARM,MS)
Entity Type:Individual
Prefix:MR
First Name:BRIJESH
Middle Name:SURESH
Last Name:MARU
Suffix:
Gender:M
Credentials:BPHARM,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 GREENSTONE BLVD APT 100
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5504
Mailing Address - Country:US
Mailing Address - Phone:989-545-1789
Mailing Address - Fax:
Practice Address - Street 1:27440 US HIGHWAY 27 FL 8291
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-8291
Practice Address - Country:US
Practice Address - Phone:352-728-8083
Practice Address - Fax:989-445-3779
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035614183500000X
FL48672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist