Provider Demographics
NPI:1861714685
Name:PULICKAL, SANTHOSH JOHN (RPH)
Entity type:Individual
Prefix:
First Name:SANTHOSH
Middle Name:JOHN
Last Name:PULICKAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2901
Mailing Address - Country:US
Mailing Address - Phone:516-739-2408
Mailing Address - Fax:516-739-1659
Practice Address - Street 1:1 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2901
Practice Address - Country:US
Practice Address - Phone:516-739-2408
Practice Address - Fax:516-739-1659
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist