Provider Demographics
NPI:1164138020
Name:KURIAN, JAISON
Entity Type:Individual
Prefix:
First Name:JAISON
Middle Name:
Last Name:KURIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 WEST LOOP
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-8020
Mailing Address - Country:US
Mailing Address - Phone:979-543-6280
Mailing Address - Fax:979-543-3249
Practice Address - Street 1:3413 WEST LOOP
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-8020
Practice Address - Country:US
Practice Address - Phone:979-543-6280
Practice Address - Fax:979-543-3249
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist