Provider Demographics
NPI:1841433117
Name:AGARWAL, SURESH KUMAR
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:KUMAR
Last Name:AGARWAL
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 1:109 N WHITTEMORE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1649
Mailing Address - Country:US
Mailing Address - Phone:989-224-2313
Mailing Address - Fax:989-227-9583
Practice Address - Street 1:109 N WHITTEMORE ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1649
Practice Address - Country:US
Practice Address - Phone:989-224-2313
Practice Address - Fax:989-227-9583
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist