Healthcare Provider Details

I. General information

NPI: 1528367760
Provider Name (Legal Business Name): POOJA GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 PULASKI HWY
BEAR DE
19701-1708
US

IV. Provider business mailing address

1999 PULASKI HWY
BEAR DE
19701-1708
US

V. Phone/Fax

Practice location:
  • Phone: 302-832-9772
  • Fax:
Mailing address:
  • Phone: 302-832-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003767
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: