Provider Demographics
NPI:1235464611
Name:KALATHIL, ABRAHAM V (RPH)
Entity Type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:V
Last Name:KALATHIL
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:JUNCTION OF STATE HIGHWAY 371 & NAVAJO ROUTE 9
Mailing Address - Street 2:P.O. BOX 358
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313
Mailing Address - Country:US
Mailing Address - Phone:505-786-6344
Mailing Address - Fax:505-786-2526
Practice Address - Street 1:JUNCTION OF STATE HIGHWAY 371 & NAVAJO ROUTE 9
Practice Address - Street 2:
Practice Address - City:CROWNPOINT
Practice Address - State:NM
Practice Address - Zip Code:87313
Practice Address - Country:US
Practice Address - Phone:505-786-6344
Practice Address - Fax:505-786-2526
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043893L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist