Healthcare Provider Details

I. General information

NPI: 1962409532
Provider Name (Legal Business Name): GUPTA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 GRAND AVE
ENGLEWOOD NJ
07631-4934
US

IV. Provider business mailing address

543 GRAND AVE
ENGLEWOOD NJ
07631-4934
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-9378
  • Fax: 201-568-9226
Mailing address:
  • Phone: 201-568-9378
  • Fax: 201-568-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00354100
License Number StateNJ

VIII. Authorized Official

Name: LAYAK GUPTA
Title or Position: PIC
Credential: RPH
Phone: 201-568-9378