Provider Demographics
NPI:1841944741
Name:KAKAL, BURHANUDDIN MOEZ (RPH)
Entity type:Individual
Prefix:
First Name:BURHANUDDIN
Middle Name:MOEZ
Last Name:KAKAL
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 1:89 NH ROUTE 25
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-6314
Mailing Address - Country:US
Mailing Address - Phone:603-279-4551
Mailing Address - Fax:602-279-3060
Practice Address - Street 1:89 NH ROUTE 26
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253
Practice Address - Country:US
Practice Address - Phone:603-279-4451
Practice Address - Fax:603-279-3060
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-01292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHPHCY-01292OtherNEW HAMPSHIRE BOARD OF PHARMACY - PHARMACIST LICENSE