Provider Demographics
NPI:1083825285
Name:KUNDI, SASHI BALA
Entity Type:Individual
Prefix:MS
First Name:SASHI
Middle Name:BALA
Last Name:KUNDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 CREEKVIEW TER
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3853
Mailing Address - Country:US
Mailing Address - Phone:517-347-1275
Mailing Address - Fax:
Practice Address - Street 1:1784 CREEKVIEW TER
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3853
Practice Address - Country:US
Practice Address - Phone:517-347-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist