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General NPI Number Information
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NPI Number | 1881993566
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Entity Type | Individual
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Provider Name | MR. SENTHIL GANESH MARIMUTHU
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Gender | Male
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 11/22/2014
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Provider Practice Location Address
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Address Line | 850 UNIVERSITY CITY BLVD
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City | BLACKSBURG
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State | VA
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Zip | 24060-2708
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Country | US
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Telephone | 540-552-7716
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Fax | 540-961-5709
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Provider Business Mailing Address
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Address Line | 1412 HONEYSUCKLE DR
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City | BLACKSBURG
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State | VA
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Zip | 24060-0391
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Country | US
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Telephone | 540-320-3345
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Fax | 540-961-5709
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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 | 0202206723
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License Number State | VA
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