Provider Demographics
NPI:1174805543
Name:THURUTHIKKARA, ANULA (RPH)
Entity type:Individual
Prefix:MISS
First Name:ANULA
Middle Name:
Last Name:THURUTHIKKARA
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 1:4283 CANBERRA AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9G 3E5
Mailing Address - Country:CA
Mailing Address - Phone:519-903-5682
Mailing Address - Fax:
Practice Address - Street 1:6331 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4317
Practice Address - Country:US
Practice Address - Phone:313-567-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2020-07-01
Deactivation Date:2020-06-25
Deactivation Code:
Reactivation Date:2020-07-01
Provider Licenses
StateLicense IDTaxonomies
MI5302037726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist