Healthcare Provider Details

I. General information

NPI: 1114924776
Provider Name (Legal Business Name): ERIC K GUPTA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 PALM AVE
SAN GABRIEL CA
91776-3012
US

IV. Provider business mailing address

1029 PALM AVE
SAN GABRIEL CA
91776-3012
US

V. Phone/Fax

Practice location:
  • Phone: 909-469-5412
  • Fax: 909-469-5539
Mailing address:
  • Phone: 909-469-5412
  • Fax: 909-469-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number52275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: