Provider Demographics
NPI:1174957351
Name:KURIAKOSE, SHAWN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:KURIAKOSE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 MARSH LN
Mailing Address - Street 2:T-0947
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4924
Mailing Address - Country:US
Mailing Address - Phone:214-357-3980
Mailing Address - Fax:
Practice Address - Street 1:9440 MARSH LN
Practice Address - Street 2:T-0947
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4924
Practice Address - Country:US
Practice Address - Phone:214-357-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist