Healthcare Provider Details

I. General information

NPI: 1013450121
Provider Name (Legal Business Name): POONAM GUPTA PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8737 VAN NUYS BLVD UNIT B
PANORAMA CITY CA
91402-2401
US

IV. Provider business mailing address

8737 VAN NUYS BLVD UNIT B
PANORAMA CITY CA
91402-2401
US

V. Phone/Fax

Practice location:
  • Phone: 818-810-6918
  • Fax: 818-810-9168
Mailing address:
  • Phone: 818-810-6918
  • Fax: 818-810-9168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: