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General NPI Number Information
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NPI Number | 1629367503
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Entity Type | Individual
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Provider Name | BRIJESH SURESH MARU BPHARM,MS
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Gender | Male
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 27440 US HIGHWAY 27 FL 8291 WALGREENS PHARMACY
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City | LEESBURG
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State | FL
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Zip | 34748-8291
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Country | US
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Telephone | 352-728-8083
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Fax | 989-445-3779
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Provider Business Mailing Address
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Address Line | 1110 GREENSTONE BLVD APT 100
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City | LAKE MARY
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State | FL
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Zip | 32746-5504
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Country | US
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Telephone | 989-545-1789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302035614
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 48672
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License Number State | FL
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