Healthcare Provider Details

I. General information

NPI: 1043500630
Provider Name (Legal Business Name): RAJESH K GUPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16605 E PALISADES BLVD
FOUNTAIN HILLS AZ
85268-3716
US

IV. Provider business mailing address

16605 E PALISADES BLVD
FOUNTAIN HILLS AZ
85268-3716
US

V. Phone/Fax

Practice location:
  • Phone: 480-391-4021
  • Fax:
Mailing address:
  • Phone: 480-391-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016427
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: