Provider Demographics
NPI:1649888140
Name:KALOLA, PRITESH B
Entity type:Individual
Prefix:
First Name:PRITESH
Middle Name:B
Last Name:KALOLA
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 1:2372 HARPERS WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5176
Mailing Address - Country:US
Mailing Address - Phone:404-483-0024
Mailing Address - Fax:
Practice Address - Street 1:1090 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1920
Practice Address - Country:US
Practice Address - Phone:678-546-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist