Provider Demographics
NPI:1639469810
Name:MENON, VASANT K
Entity Type:Individual
Prefix:MR
First Name:VASANT
Middle Name:K
Last Name:MENON
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 1:3050 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2415
Mailing Address - Country:US
Mailing Address - Phone:989-792-9606
Mailing Address - Fax:989-792-0760
Practice Address - Street 1:3050 BAY RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2415
Practice Address - Country:US
Practice Address - Phone:989-792-9606
Practice Address - Fax:989-792-0760
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist