Provider Demographics
NPI:1215363585
Name:KURIAN, ROGER GEORGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:GEORGE
Last Name:KURIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W WILLOW KNOLLS DR
Mailing Address - Street 2:APT 706
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1449
Mailing Address - Country:US
Mailing Address - Phone:847-620-9164
Mailing Address - Fax:
Practice Address - Street 1:1919 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1825
Practice Address - Country:US
Practice Address - Phone:309-692-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist