Provider Demographics
NPI:1174242010
Name:KALU, KALU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KALU
Middle Name:
Last Name:KALU
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 1:90 MAIN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4011
Mailing Address - Country:US
Mailing Address - Phone:774-517-5528
Mailing Address - Fax:
Practice Address - Street 1:90 MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4011
Practice Address - Country:US
Practice Address - Phone:774-517-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist