Provider Demographics
NPI:1689330086
Name:LALA, KUNTAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KUNTAL
Middle Name:
Last Name:LALA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 RANDOLPH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1081
Mailing Address - Country:US
Mailing Address - Phone:704-365-0707
Mailing Address - Fax:704-442-9870
Practice Address - Street 1:3541 RANDOLPH RD STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1081
Practice Address - Country:US
Practice Address - Phone:704-365-0707
Practice Address - Fax:704-442-9870
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC185861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist