Provider Demographics
NPI:1982192399
Name:KURIAN, JERIL ROGER
Entity Type:Individual
Prefix:
First Name:JERIL
Middle Name:ROGER
Last Name:KURIAN
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 1:3323 VILLAGE POND LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8783
Mailing Address - Country:US
Mailing Address - Phone:832-265-7155
Mailing Address - Fax:
Practice Address - Street 1:1311 W SAM HOUSTON PKWY N STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4015
Practice Address - Country:US
Practice Address - Phone:800-511-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0508611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist