Provider Demographics
NPI:1144655382
Name:MANTHURUTHIL, TINU (PHARMD)
Entity type:Individual
Prefix:
First Name:TINU
Middle Name:
Last Name:MANTHURUTHIL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W MCDERMOTT DR
Mailing Address - Street 2:T-1231
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:907 W MCDERMOTT DR
Practice Address - Street 2:T-1231
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6503
Practice Address - Country:US
Practice Address - Phone:972-396-9486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist