Provider Demographics
NPI:1003193376
Name:KURIAN, SANTHOSH (RPH)
Entity Type:Individual
Prefix:MR
First Name:SANTHOSH
Middle Name:
Last Name:KURIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SANTA FE TRL
Mailing Address - Street 2:APT# 250
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4611
Mailing Address - Country:US
Mailing Address - Phone:972-924-5731
Mailing Address - Fax:
Practice Address - Street 1:1701 W SOUTHLAKE BLVD
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6803
Practice Address - Country:US
Practice Address - Phone:817-488-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49210183500000X
AZS017720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX49210OtherPHARMACIST LICENSE
AZS017720OtherPHARMACIST LICENSE