Provider Demographics
NPI:1881993566
Name:MARIMUTHU, SENTHIL GANESH
Entity type:Individual
Prefix:MR
First Name:SENTHIL
Middle Name:GANESH
Last Name:MARIMUTHU
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 1:1412 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-0391
Mailing Address - Country:US
Mailing Address - Phone:540-320-3345
Mailing Address - Fax:540-961-5709
Practice Address - Street 1:850 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2708
Practice Address - Country:US
Practice Address - Phone:540-552-7716
Practice Address - Fax:540-961-5709
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7153150001Medicare NSC