Provider Demographics
NPI:1053063784
Name:KURUVILLA, MONICA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:ANN
Last Name:KURUVILLA
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 1:210 ROYDER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-3922
Mailing Address - Country:US
Mailing Address - Phone:405-371-1645
Mailing Address - Fax:
Practice Address - Street 1:12946 DAIRY ASHFORD RD STE 450
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4643
Practice Address - Country:US
Practice Address - Phone:346-279-0497
Practice Address - Fax:346-279-0498
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18079183500000X
TX63509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist