MEDICARE: SURESH MARIMUTHU PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS43137	FL

General Provider Information

NPI Number	:	1467070847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURESH MARIMUTHU PHARMACIST

Provider Business Mailing Address
First Line	:	2939 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5962
Country	:	US
Telephone Number	:	561-855-7802
Fax Number	:	561-899-3614

Provider Business Practice Location Address
First Line	:	2939 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5962
Country	:	US
Telephone Number	:	561-855-7802
Fax Number	:	561-899-3614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2020
Last Update Date	:	07/11/2020

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