Healthcare Provider Details

I. General information

NPI: 1336871292
Provider Name (Legal Business Name): ISHA GUPTA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 HILLSIDE AVE
NEW HYDE PARK NY
11040-2712
US

IV. Provider business mailing address

80 EAST ST
NEW HYDE PARK NY
11040-1325
US

V. Phone/Fax

Practice location:
  • Phone: 518-466-5495
  • Fax:
Mailing address:
  • Phone: 518-466-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: