Healthcare Provider Details

I. General information

NPI: 1851846745
Provider Name (Legal Business Name): ASHWANI KUMAR GUPTA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 WAKEFIELD PINES DR
RALEIGH NC
27614-9826
US

IV. Provider business mailing address

2724 APPLEDOWN DR
CARY NC
27513-4097
US

V. Phone/Fax

Practice location:
  • Phone: 919-569-6741
  • Fax:
Mailing address:
  • Phone: 856-470-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26469
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: