=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417766684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MINIMOL KURIAKOSE RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2025
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35780 STATE ROAD 54 STE 101
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33541-2242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-782-4854
-----------------------------------------------------
Fax | 813-782-4856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35780 STATE ROAD 54 STE 101
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33541-2242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-782-4854
-----------------------------------------------------
Fax | 813-782-4856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS35332
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------