MEDICARE: GNANAVEL MUNIRATHINAM 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	13915	MD

General Provider Information

NPI Number	:	1063608412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GNANAVEL MUNIRATHINAM PHARMACIST

Provider Business Mailing Address
First Line	:	19 E FREDERICK ST
Second Line	:
City	:	WALKERSVILLE
State	:	MD
Zip	:	21793-8234
Country	:	US
Telephone Number	:	301-845-4401
Fax Number	:	301-845-1114

Provider Business Practice Location Address
First Line	:	19 E FREDERICK ST
Second Line	:
City	:	WALKERSVILLE
State	:	MD
Zip	:	21793-8234
Country	:	US
Telephone Number	:	301-845-4401
Fax Number	:	301-845-1114

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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