Healthcare Provider Details

I. General information

NPI: 1629294855
Provider Name (Legal Business Name): AJAY GUPTA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HIGH ST
NASHUA NH
03060-3312
US

IV. Provider business mailing address

5 JASON DR
MERRIMACK NH
03054-2542
US

V. Phone/Fax

Practice location:
  • Phone: 603-816-6958
  • Fax:
Mailing address:
  • Phone: 603-930-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3334
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 04360
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26829
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: