Provider Demographics
NPI:1417766684
Name:KURIAKOSE, MINIMOL (RPH)
Entity type:Individual
Prefix:
First Name:MINIMOL
Middle Name:
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35780 STATE ROAD 54 STE 101
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-2242
Mailing Address - Country:US
Mailing Address - Phone:813-782-4854
Mailing Address - Fax:813-782-4856
Practice Address - Street 1:35780 STATE ROAD 54 STE 101
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-2242
Practice Address - Country:US
Practice Address - Phone:813-782-4854
Practice Address - Fax:813-782-4856
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist