Healthcare Provider Details

I. General information

NPI: 1174046023
Provider Name (Legal Business Name): RISHITA SUMIT GUPTA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 6TH AVE
NEW YORK NY
10011-8422
US

IV. Provider business mailing address

475 6TH AVE
NEW YORK NY
10011-8422
US

V. Phone/Fax

Practice location:
  • Phone: 212-337-3242
  • Fax:
Mailing address:
  • Phone: 212-337-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065298-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: