Provider Demographics
NPI:1588822381
Name:KURUP, KANAN SHREEKUMAR
Entity Type:Individual
Prefix:
First Name:KANAN
Middle Name:SHREEKUMAR
Last Name:KURUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15890 SOQUEL CANYON PKWY
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7927
Mailing Address - Country:US
Mailing Address - Phone:909-597-3950
Mailing Address - Fax:909-393-7348
Practice Address - Street 1:15890 SOQUEL CANYON PKWY
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-7927
Practice Address - Country:US
Practice Address - Phone:909-597-3950
Practice Address - Fax:909-393-7348
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH51519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist