Provider Demographics
NPI:1710269964
Name:SANKARAMANGALATH, ABRAHAM K (MPHARM, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:K
Last Name:SANKARAMANGALATH
Suffix:
Gender:M
Credentials:MPHARM, PHARMD
Other - Prefix:MR
Other - First Name:ABRAHAM
Other - Middle Name:
Other - Last Name:KURUVILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6730 US HIGHWAY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 E MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-1766
Practice Address - Country:US
Practice Address - Phone:863-688-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist