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General NPI Number Information
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NPI Number | 1992579700
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Entity Type | Individual
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Provider Name | ROSHAN GEORGE KOPPUZHAYIL
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Gender | Male
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 6128 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77551-1030
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Country | US
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Telephone | 409-740-0876
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Fax |
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Provider Business Mailing Address
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Address Line | 3910 SAWYER BEND LN
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City | SUGAR LAND
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State | TX
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Zip | 77479-7122
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Country | US
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Telephone | 832-495-5597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 47827
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License Number State | TX
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