Healthcare Provider Details

I. General information

NPI: 1417880535
Provider Name (Legal Business Name): ANJOL KURIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 FLOYD AVE
MODESTO CA
95355-9604
US

IV. Provider business mailing address

1048 MONO ST
MANTECA CA
95337-7987
US

V. Phone/Fax

Practice location:
  • Phone: 209-551-4867
  • Fax:
Mailing address:
  • Phone: 209-582-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: