Provider Demographics
NPI:1164022554
Name:PANAMPUNNA, KURIAN TITUS
Entity type:Individual
Prefix:
First Name:KURIAN
Middle Name:TITUS
Last Name:PANAMPUNNA
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 1:233 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-8745
Mailing Address - Country:US
Mailing Address - Phone:717-683-0376
Mailing Address - Fax:
Practice Address - Street 1:698 SHREWSBURY COMMONS AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1617
Practice Address - Country:US
Practice Address - Phone:717-235-7544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist