Healthcare Provider Details

I. General information

NPI: 1487800496
Provider Name (Legal Business Name): KRISHNA GUPTA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2008
Last Update Date: 08/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MEETINGHOUSE CIR
SICKLERVILLE NJ
08081-4896
US

IV. Provider business mailing address

61 MEETINGHOUSE CIR
SICKLERVILLE NJ
08081-4896
US

V. Phone/Fax

Practice location:
  • Phone: 484-686-5897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02988600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP438194
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: