Provider Demographics
NPI:1588075717
Name:CURYLO, J
Entity type:Individual
Prefix:
First Name:J
Middle Name:
Last Name:CURYLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628
Mailing Address - Country:US
Mailing Address - Phone:574-273-3410
Mailing Address - Fax:574-273-3465
Practice Address - Street 1:3600 N PORTAGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628
Practice Address - Country:US
Practice Address - Phone:574-273-3410
Practice Address - Fax:574-273-3465
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017531A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy