Provider Demographics
NPI:1043705213
Name:LAL, AMIT
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:LAL
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 1:4 MAE LN
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-6061
Mailing Address - Country:US
Mailing Address - Phone:201-918-7213
Mailing Address - Fax:
Practice Address - Street 1:79 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1704
Practice Address - Country:US
Practice Address - Phone:203-234-7461
Practice Address - Fax:203-234-7468
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist