Provider Demographics
NPI:1073833307
Name:KALADA, KENNETH
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:KALADA
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 1:1306 RTE 33
Mailing Address - Street 2:UNIT 4
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-4033
Mailing Address - Country:US
Mailing Address - Phone:732-938-5545
Mailing Address - Fax:732-938-5540
Practice Address - Street 1:1306 RTE 33
Practice Address - Street 2:UNIT 4
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-4033
Practice Address - Country:US
Practice Address - Phone:732-938-5545
Practice Address - Fax:732-938-5540
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12788183500000X
NJ288RI012788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist