Provider Demographics
NPI:1497308902
Name:KURIAKOSE, SMITHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:KURIAKOSE
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 1:730 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2312
Mailing Address - Country:US
Mailing Address - Phone:215-627-6433
Mailing Address - Fax:
Practice Address - Street 1:730 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2312
Practice Address - Country:US
Practice Address - Phone:215-627-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
XOtherPHARMACIST
RP452759OtherPHARMACIST
PAPHARMACYOtherPHARMACY
PA1467541193OtherPHARMACY