Provider Demographics
NPI:1194109967
Name:MANUVEL, MARY KALAIARASI (RPH)
Entity type:Individual
Prefix:
First Name:MARY KALAIARASI
Middle Name:
Last Name:MANUVEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 S WESTNEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1455
Mailing Address - Country:US
Mailing Address - Phone:269-381-4862
Mailing Address - Fax:269-381-4943
Practice Address - Street 1:5933 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1455
Practice Address - Country:US
Practice Address - Phone:269-381-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist